• 보건행정학회지
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• 제31권1호
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• pp.114-124
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• 2021

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

• 보건행정학회지
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• 제31권1호
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• pp.74-90
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• 2021

Background: It is getting important to improve the oral health status of the elderly because oral health status may affect their health status of the whole body. In this respect, we aimed to explore the association of oral health status and behavior factors with self-rated health status by sex. Methods: Using the data from the 7th Korea National Health and Nutrition Examination Survey for health surveys and oral examinations (2016-2018), we analyzed a total of 3,070 people aged 65 or older (men: 1,329; women: 1,741). Our dependent variable, self-rated health status, was divided into two groups: not good (bad and very bad) and good (very good, good, and fair), whereas our independent variables of interest were oral health status and behavior factors. In addition to descriptive analysis and the Rao-Scott chi-square test, reflecting survey characteristics, we conducted hierarchical multivariable logistic regression analyses adjusted for socio-demographics and health status and behavior factors. All analyses were stratified by sex. Results: The proportion of people having 'not good' self-rated health was 36.5% in women but 24.5% in men. In a model adjusted for all covariates, the self-rated health status showed significant association with the self-rated oral health status. For example, in men, the risk of having 'not good' self-rated health was high in people having 'poor' (odds ratio [OR], 5.31; 95% confidence interval [CI], 2.34-12.03) self-rated oral health status and in those having 'fair' (OR, 4.03; 95% CI, 1.68-9.70) in comparison with those having 'good' self-rated oral health status. Dental status regarding speaking difficulty seemed to be very important in influencing self-rated health status. For instance, in women, compared to people having 'no discomfort' speaking difficulty, the risk of having 'not good' self-rated health was high in people having 'not bad' (OR, 1.60; 95% CI, 1.14-2.24) and 'discomfort' (OR, 1.79; 95% CI, 1.30-2.47) speaking difficulty. The covariates significantly associated with the risk of having 'not good' self-rated health were: physical activity, chronic disease, stress, and body mass index in both sexes; health insurance type and drinking only in men; and economic activity only in women. Conclusion: Oral health status and behavioral factors were associated with self-rated health status among the elderly, differently by sex. This suggests that public health policies toward better health in the elderly should take their oral health status and oral health behaviors into account in a sex-specific way.

• 한국수자원학회논문집
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• 제53권12호
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• pp.1049-1057
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• 2020

본 연구는 드론을 이용하여 홍수기 하천에서의 유량측정방법 개발을 위해 수행하였다. 홍수기 유량측정은 예산, 인력, 안전 및 하천공사 등의 문제로 매년 모든 지점에서 유량 측정을 실시하지 못하는 어려움이 있다. 특히 태풍 등 큰 호우사상 발생 시 수위-유량관계 변화 검토가 필요하지만 앞에서 언급한 문제 등으로 인하여 측정에 어려움이 있다. 이런 문제점을 개선하기 위해 최소 인력이 단시간 간편하게 측정할 수 있는 방법을 개발하였다. 항공사진측량 개념으로 접근하여 의정부시(신곡교) 지점과 영동군(영동제2교) 지점 하도 주변에 확인 가능한 위치에 지상기준점(GCP, Ground Control Points) 4개점을 선점하고 VRS DGPS 장비를 이용하여 좌표측량을 수행하였다. 드론을 일정높이의 정지상태(Hovering)에서 하도 내 수 표면을 카메라의 인터벌 기능으로 3초 간격 정사영상을 촬영하였다. 정사 촬영된 항공사진의 좌표계를 평면지각좌표계인 GRS80 TM좌표계로 정의한 후 GCP 좌표를 활용하여 보다 정밀하게 정사보정을 실시하였다. 수표면에 유하하는 부유물의 3초 간격 위치를 X, Y좌표 분석을 통해 이동거리를 평균유속으로 산정하고 유하경로에 따른 통수단면적을 적용하여 유량을 산정하였다. 따라서 항공사진측량 기법을 적용하여 홍수기에 드론을 이용한 유량측정방법에 대한 적용성을 확인하였다.

• 한국의료질향상학회지
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• 제27권2호
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• pp.18-29
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• 2021

Purpose: Patients with hematologic malignancy (HM) typically have a high mortality rate when their condition deteriorates. The chronic progressive course of the disease makes it difficult to assess the effect of intervention on acute events. We investigated the effectiveness of a rapid response team (RRT) on in-hospital mortality in patients with HM. Methods: We retrospectively analyzed the data of patients with HM who admitted to the medical intensive care unit between 2006 and 2015. Clinical outcomes before and after RRT implementation were evaluated. Results: A total of 228 patients in the pre-RRT period and 781 patients in the post-RRT period were included. The overall in-hospital mortality was 55.4%. Patients in the post-RRT period had improved survival; however, they required more vasopressor therapy, continuous renal replacement therapy, and extracorporeal membrane oxygenation. Multivariate analysis revealed that in-hospital mortality was associated with RRT activation (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.498-0.807; p < .001), neurological disease (HR, 2.007; 95% CI, 1.439-2.800; p < .001), sequential organ failure assessment score (HR, 1.085; 95% CI, 1.057-1.112; p < .001), need for continuous renal replacement therapy (HR, 1.608; 95% CI, 1.206-1.895; p< .001), mechanical ventilation (HR, 1.512; 95% CI, 1.206-1.895; p< .001), vasopressor (HR, 1.598; 95% CI, 1.105-2.311; p = .013), and extracorporeal membrane oxygenation (HR, 1.728; 95% CI, 1.105-2.311; p = .030). Conclusion: RRT activation may be associated with improved survival in patients with HM.

• Journal of Chest Surgery
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• 제55권5호
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• pp.378-387
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• 2022

Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database. Methods: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision. Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib. Conclusion: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

• 한국가정과교육학회지
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• 제33권4호
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• pp.103-117
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• 2021

본 연구의 목적은 한국 성인(19-69세)들의 견과류 섭취량과 고혈압의 연관성 및 성인들의 수면시간에 따른 견과류 섭취량과 고혈압의 연관성을 분석하는 것이다. 2010-2016 국민건강영양조사 자료를 활용하여 분석하였고, 25,359명의 연구 대상자가 포함되었다. 본 연구에서는 수면시간에 따른 견과류섭취와 고혈압의 연관성을 분석하였다. 수면시간에 따른 견과류섭취와 고혈압의 연관성을 알아보기위해 로지스틱 회귀분석(logistic regression)을 사용하여 교차비(odds ratio, OR)와 95% 신뢰구간(confidence interval, CI)으로 제시하였다. 자료의 통계처리 및 분석은 SAS 9.4 for windows(SAS Institute Inc, Cary, NC USA)를 이용하였고, 통계적 유의수준은 α=0.05로 설정하였다. 분석결과, 견과류 섭취량이 증가할수록 고혈압 유병률이 통계적으로 유의하게 감소한 것으로 나타났다(p for trend=0.02). 또한, 수면시간이 6시간 이상 7시간 미만인 대상자의 경우에는, 견과류 섭취량이 증가할수록 고혈압 유병률이 통계적으로 유의하게 감소하는 경향을 보였고(p for trend=0.03), DBP가 감소하는 것을 알 수 있었다(p for trend=0.01). 결론적으로, 견과류 섭취와 고혈압유병은 연관성이 있었고, 특히 수면시간이 6시간 이상, 7시간 미만 또는 7시간 이상 8시간 미만인 경우에도 견과류를 많이 섭취할수록 고혈압 유병률이 감소하였다.

• 지역연구
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• 제38권2호
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• pp.59-72
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• 2022

기후 변화와 보행자 권리에 대한 인식이 높아짐에 따라, 서울시는 차 없는 거리 정책을 적용하여 왔다. 특히 지자체와 민간은 도시 활력 증진과 소비자 유인이라는 공통의 이해관계에 따라 합의를 통해 차 없는 거리를 도입하고 있다. 하지만 국내의 차 없는 거리 정책에 대하여 정책의 효과를 실증적으로 살펴본 연구는 미비한 실정이며, 특히 COVID-19 이후 기간에서 차 없는 거리 정책을 살펴본 연구는 전무하다. 이에 따라 본 연구는 차 없는 거리가 도입된 상업 거리인 종로 52길에 대하여 통제집단합성법을 활용하여 정책의 효과를 평가하였다. 분석 결과, 종로 52길에서의 차 없는 거리 정책은 유입 인구 증대를 통해 도시 활력 증진에 유의한 효과가 있는 것으로 나타났다. 또한, 분석 결과에 따라 정책이 효과를 보이기까지 3개월가량이 소요된 점을 고려할 때 정책의 효과를 평가하기 위해선 적정한 시간 간격이 필요함을 시사했다. 그러나 정책 시행으로부터 1년이 경과하기 전에 종로 52길에서 생활인구 밀도 증가 효과는 유의하지 않게 나타났다. 또한, COVID-19 시기에는 합성통제지역보다 생활인구 밀도가 오히려 감소한 것으로 나타났다. 본 연구의 결과는 차 없는 거리 정책에 대해 보다 장기적인 관점의 인구 유입 전략과 감염병 확산 하에서 유연한 대응 방안이 필요함을 시사한다.

• Journal of Chest Surgery
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• 제54권6호
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• pp.480-486
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• 2021

Background: Although various methods are already used to calculate predicted postoperative forced expiratory volume in 1 second (FEV₁) based on preoperative FEV₁ in lung surgery, the predicted postoperative FEV₁ is not always the same as the actual postoperative FEV₁. Observed postoperative FEV₁ values are usually the same or higher than the predicted postoperative FEV₁. To overcome this issue, we investigated the relationship between the number of resected lung segments and the discordance of preoperative and postoperative FEV₁ values. Methods: From September 2014 to May 2020, the data of all patients who underwent anatomical lung resection by video-assisted thoracoscopic surgery (VATS) were gathered and analyzed retrospectively. We investigated the association between the number of resected segments and the differential FEV₁ (a measure of the discrepancy between the predicted and observed postoperative FEV₁) using the t-test and linear regression. Results: Information on 238 patients who underwent VATS anatomical lung resection at Kyung Hee University Hospital at Gangdong and by DH. Kim for benign and malignant disease was collected. After applying the exclusion criteria, 114 patients were included in the final analysis. In the multiple linear regression model, the number of resected segments showed a positive correlation with the differential FEV₁ (Pearson r=0.384, p<0.001). After adjusting for multiple covariates, the differential FEV₁ increased by 0.048 (95% confidence interval, 0.023-0.073) with an increasing number of resected lung segments (R²=0.271, p<0.001). Conclusion: In this study, after pulmonary resection, the number of resected segments showed a positive correlation with the differential FEV₁.

• Journal of Trauma and Injury
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• 제35권2호
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• pp.84-91
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• 2022

Purpose: The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients. Methods: We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0-18 years), adults (19-59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections. Results: Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16-48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279-12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488-10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167-10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221-5.475; P=0.013). Conclusions: When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.269-275
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• 2022

Objective : The coronavirus disease 2019 (COVID-19) pandemic is affecting the characteristics of patients with head injuries. This study aimed to evaluate the effect of the COVID-19 pandemic on patients with head injuries at a regional emergency medical center in South Korea. Methods : From April 2019 to November 2020, 350 patients with head injuries were admitted to our hospital. The study period was divided into the pre-COVID-19 (n=169) and COVID-19 (n=181) eras (10 months each). Patients with severe head injuries requiring surgery (n=74) were categorized into those who underwent surgery (n=41) and those who refused surgery (n=33). Results : Head injuries in pediatric patients (<3 years) were more frequent in the COVID-19 era than in the pre-COVID-19 era (8.8% vs. 3.6%, p=0.048). More patients refused surgery in the COVID-19 era than in the pre-COVID-19 era (57.9% vs. 30.6%, p=0.021). Refusal of surgery was associated with old age (67.7±14.5 vs. 52.4±19.1, p<0.001), marital status (married, 84.8% vs. 61.0%, p=0.037), unemployment (42.4% vs. 68.3%, p=0.034), COVID-19 era (66.7% vs. 39.0%, p=0.021), and lower Glasgow coma scale scores (6.12±3.08 vs. 10.6±3.80, p<0.001). Multivariable logistic regression analysis revealed that refusal of surgery was independently associated with old age (adjusted odds ratio [OR], 1.084; 95% confidence interval [CI], 1.030-1.140; p=0.002), COVID-19 era (adjusted OR, 6.869; 95% CI, 1.624-29.054; p=0.009), and lower Glasgow coma scale scores (adjusted OR, 0.694; 95% CI, 0.568-0.848; p<0.001). Conclusion : We observed an increased prevalence of head injuries in pediatric patients (<3 years) during the COVID-19 pandemic. Additionally, among patients with severe head injuries requiring surgery, more patients refused to undergo surgery during the COVID-19 pandemic.