요추협착증에 대한 양공접근내시경감압술과 감압동반유합술의 임상적 결과 및 의료비용에 대한 비교 분석

최대정 충북대학교 2019 국내박사

Spinal stenosis is one of most common degenerative diseases in elderly patients over the age of 60. Various treatment options are not simply focused on decreasing of back pain but also on improving the quality of life for older patients. Wider decompression with fusion and posterior instrumentation had been thought once as the gold standard ;however, it has become apparent that this technique can lead to severe postoperative complications and patient disabilities. Wider decompressive spine surgery should be changed to minimally invasive surgery by using several facilities such as loupe, microscope, tubular retractor, endoscope or arthroscope. Minimally invasive decompression with fusion using a microscope and a tubular retractor was developed to decrease paravertebral muscle injury and blood loss. This can guarantee clear discrimination of structures for safer manipulation of neural structures, but narrower working space through a tubular retractor may not be helpful in preserving bony structures to keep the spinal stability. Therefore, minimally invasive fusion surgery became more prevalent. Percutaneous uniportal endoscopic spine surgery was developed for disc problem and it has been adapted to decompression without fusion by preserving spinal bony structures in these days. But indication of uniportal endoscopic spine surgery has very shallow and the clinical results of this technique could not overcome those of minimally invasive decompression with fusion due to its technical trait.  Biportal endoscopic decompression uses two skin incision about 1cm in length to insert an arthroscope and a certain instrument for decompression surgery. With no muscle dissection and less bleeding, the spinal structures deeper inside can be accessed and decompressed while preserving spinal stability. Consequently, it can make it possible to perform decompression-only even for severe degenerative spinal stenosis. Complications associated with wider skin incision and excess distraction of muscles, wound infection and muscle atrophy with open dissection, adjacent segment disease and additional fusion surgery with rigid fusion and instrumentation can be escapable and preventable. The medical cost for additional revision surgery in early following-up due to severe postoperative complications also could be reduced according to the lower range of surgical intervention and less minor complications of biportal endoscopic decompression. This study proceeded to reveal benefits of clinical and economic point of views in this brand-new technique, biportal endoscopic decompression, for degenerative lumbar spinal stenosis.

코로나19 유행으로 인한 음주행태 변화

신여경 충북대학교 2022 국내석사

Purpose: The purpose of this study is to identify factors affecting drinking in social disaster situations such as COVID-19 and use them as reference materials for public health business. Method: This study used data from the Community Health Survey of the Korea Centers for Disease Control and Prevention in 2019 and 2020, and targeted 453,127 adults aged 19 or older living in 17 regions nationwide. Gender, age, occupation, education level, marital status, and income were extracted from to population sociological characteristics and As health-related characteristics, smoking status, subjective stress, and depression experiences were extracted. and As Regional characteristics are that after extracting the type of residence and the name of the region, Drinking behavior according to the COVID-19 epidemic was analyzed. Results: The major results of this study are as follws; 1) At the time of the Corona 19 epidemic, drinking more than twice a week and high-risk drinking decreased compared to before the Corona 19 epidemic. 2) At all ages, drinking more than twice a week and high-risk drinking decreased compared to before the epidemic at the time of the COVID-19 epidemic. Drinking and high-risk drinking more than twice a week in their 30s and 50s, who social drink frequently, decreased less than other age groups. 3) At all occupations, drinking more than twice a week and high-risk drinking decreased compared to before the epidemic at the time of the COVID-19 epidemic. clerical work's Drinking more than twice a week and high-risk drinking decreased significantly compared to other jobs. 4) At the time of the Corona 19 epidemic men's than twice a week Drinking and high-risk drinking decreased compared to women. Conclusion: The conclusions of this study are as follows; 1) It is necessary to create a sobriety environment for the formation of a healthy social drinking culture. In this study, although there were some differences according to the degree of all classes and ages, the frequency of drinking more than twice a week and high-risk drinking decreased due to the effect of social distancing during the COVID-19 outbreak. It can be seen that the social drinking behavior of several people drinking together takes up a greater proportion in Korea's drinking culture than individual drinking alone. Even after the end of COVID-19, there is no way to suppress socially motivated drinking parties. Therefore, it seems that there is a need for a standard for alcohol consumption and a project to create an environment for alcohol consumption, focusing on the formation of a healthy social drinking culture. 2) It is necessary to pay attention to the drinking behavior of office workers suitable for the non-face-to-face era. The acceleration of the era of non-face-to-face work such as telecommuting and video conferencing due to COVID-19 is expected to bring about many changes to the drinking culture of office workers after the end of COVID-19. For example, a non-face-to-face drinking culture can be activated like a new drinking culture such as ‘drinking alone’ or ‘home drinking’. Therefore, it is necessary to continuously pay attention to the drinking behavior of office workers suitable for the upcoming non-face-to-face era. 3) It is expected that a project to improve awareness of drinking behavior suitable for new drinking cultures such as ‘drinking alone’ and ‘Home drinking’ will be needed. The COVID-19 epidemic has created a new drinking culture of ‘drinking alone’ and ‘home drinking,’ which are alcoholic beverages at home. Drinking at home can lead to difficult situations to control, which can lead to alcohol abuse. Therefore, it seems necessary to improve awareness of drinking behavior that fits the new drinking culture of ‘drinking alone’ and ‘home drinking’.

우리나라 병원의 이익조정에 영향을 미치는 요인

심길호 충북대학교 2023 국내박사

본 연구는 우리나라 100병상 이상 종합병원을 대상으로 2008년~2019년까지 3,433개소(병원-연도)의 표본자료를 가지고 이익조정의 경제적 동기와 수단, 그리고 보고이익 수준 분포를 검증한 연구이다. 종속변수로 재량적 발생액을 사용하였으며, 독립변수로 정치적 비용가설, 경영자보상가설, 부채계약가설에 중점을 두고 검증하였다. 정치적 비용가설의 대용변수는 급여수익, 국고보조금, 병상규모를 사용하였고, 경영자보상가설의 대용변수는 민간병원과 공공병원을 이분하여 더미변수를 사용하였으며, 부채계약가설의 대용변수로는 부채비율을 사용하였다. 첫째, 일반적으로 기업은 정치적 과정에서 발생할 수 있는 비용을 최소화 또는 효익을 최대화하기 위한 수단으로 가능한 범위 내에서 보고이익을 작게 보고할 유인이 있을 것이라는 가설이 정치적 비용가설이다. 정치적 비용가설의 대용변수인 급여수익과 병상규모 분석결과, 전체적으로는 재량적 발생액을 이용하여 당기 보고이익을 감소시키고 있다는 사실이 입증되었지만, 민간병원의 경우 통계적으로 유의하지 않았다. 국고보조금은 정치적 비용가설의 정의와 상반된 분석결과를 도출하였는데, 병원의 경우 국고보조금 지원 대상에 선정되기 위해 높은 경영성과를 제시할 필요가 있다. 따라서 보고이익을 늘리는 방향으로 회계절차를 꾀하고 있는 결과이다. 둘째, 공공소유 기업보다 민간소유 기업일수록 경영자의 개인적 성과를 보상 받기 위해 보고이익을 증가시킬 것이라는 가설이 경영자보상가설이다. 본 연구는 경영자보상가설의 정의와 상반된 결과가 도출되었다. 병원의 경우 민간병원의 경영자보다 공공병원의 경영자는 정부 정책상 임기제로 선임된 경우가 많아 이렇게 선임된 경영자는 임기 내 가능한 한 높은 경영성과를 평가 받아야 할 책무가 뒤따르기 때문이다. 셋째, 부채비율이 높은 기업일수록 채무이행조항을 위반할 가능성이 높으므로 보고이익을 증가시키는 회계절차를 선택할 것이라는 가설이 부채계약가설이다. 검증 결과 본 연구는 부채계약가설의 정의와 상반된 결과가 도출되었다. 병원에서 부채계약가설이 채택되지 않는 이유는 부채계약가설이 법인세 최소화가설에 상쇄되어 나타난 결과로 추정된다. 넷째, 국정감사에서 항상 지적하고, 사회적 이슈로 등장한 고유목적사업준비금 불공정 특혜 논란의 진위를 확인하고자 고유목적사업준비금 효과를 제거한 후, 이익조정의 경제적 동기를 검증한 결과, 부채비율은 전체 영역에 영향을 미치고, 급여수익과 국고보조금은 민간병원에만 영향을 미칠 뿐 병상규모는 전체 영역에서 영향을 미치지 않은 것으로 분석되었다. 마지막으로 보고이익 수준 분포를 검증한 결과, 일반 영리기업과 달리 흑자회피 이익조정 경향이 뚜렷하고, 각 이익조정 동기가 서로 상쇄되어 0에 근접한 임계수준으로 보고이익을 조정하는 것으로 분석되었다. 이상에서 검증된 결과를 종합하면 병원의 이익조정 동기는 로체스터학파의 실증적 회계이론인 정치적 비용가설, 경영자보상가설, 부채계약가설을 완전하게 인용하지 않고, 병원의 특성에 따라 부분적으로 인용되었다. This study verified the economic motivation and means of earnings management, and distribution of the reported earnings levels with sample data of 3,433 places (hospital-year) from 2008 to 2019, targeting general hospitals equipped with 100 or more beds in South Korea. Discretionary accruals were used as dependent variables, and the political cost hypothesis, management compensation plans hypothesis, and debt covenant hypothesis were verified as independent variables. Insurance benefit claim revenue, state subsidies, and hospital bed sizes were used as proxy variables for the political cost hypothesis; a dummy variable was used as a proxy variable for the management compensation plans hypothesis by separating private hospitals from public hospitals; and debt ratio was used as a proxy variable for the debt covenant hypothesis. First, the political cost hypothesis provides that companies may generally have incentives to report earnings as small as possible as a means of minimizing costs or maximizing benefits that may arise from the political process. Following the analysis of insurance benefit claim revenue and bed sizes, which serve as variables for the political cost hypotheses, it has generally been proven that the reported earnings for the current period are reduced using discretionary accruals, but in the case of private hospitals, it was not statistically significant. State subsidies provided the analysis results contrary to the definition of the political cost hypothesis, and it is necessary for hospitals to present high management performance in order to procure state subsidies. Hence, this results in undertaking accounting procedures with the aim of increasing the reported earnings. Second, the management compensation plans hypothesis provides that privately owned companies report greater earnings than publicly owned companies in order to compensate for the manager’s personal performance. In this study, results contradicting the definition of the management compensation plans hypothesis were derived. In the case of hospitals, managers of public hospitals are often appointed on a term basis according to the government policy as opposed to managers of private hospitals. As such, managers of public hospitals are responsible for having their management performance evaluated as highly as possible within their terms of office. Third, the debt covenant hypothesis states that companies with a higher debt ratio are more likely to violate debt agreement clauses, and that they will therefore choose an accounting procedure that can increase the reported earnings. Following the verification, this study drew results contrary to the definition of the debt covenant hypothesis. As for the reason the debt covenant hypothesis is not adopted in hospitals, it is presumed that the debt covenant hypothesis was offset by the corporate tax minimization hypothesis. Fourth, after the effect of the reserve for proper purpose business was removed to verify the authenticity of the controversy over unfair preferential treatment of the reserve for proper purpose business, which has always been pointed out in parliamentary audits and has emerged as a social issue, the economic motivation for earnings management was examined. The analysis provided that the debt ratio affected the entire hospitals, and insurance benefit claim revenue and state subsidies only affected private hospitals while bed sizes did not affect the entire hospitals. Finally, as the verification of the distribution of the reported earnings levels provided that, unlike general for-earnings companies, the tendency to management earnings to avoid a surplus was evident, and that each the economic motivation factor for earnings management offset each other and the reported earnings were adjusted to a critical level close to zero. To summarize the results verified above, for the motivation for earnings management of hospitals, the empirical accounting theories of Rochester School of the political cost hypothesis, the management compensation plans hypothesis, and debt the covenant hypothesis were not fully cited, but they were rather partially cited based on the characteristics of the hospitals.

학부모의 식습관과 구강관리 행태가 장애아동 구강건강에 미치는 영향

오희경 충북대학교 대학원 2013 국내석사

장애인구의 지속적 증가뿐만 아니라 장애발생 위험요인의 증가로 인한 장애 역시 지속적으로 증가하고 있다. 대한민국이 복지국가를 지향하는 한 장애의 범위 확대와 그 인구의 증가는 필연적이라 볼 수 있다. 장애 인구의 증가와 함께 그들의 건강관리 또한 사회적 관심이 증가하고 있다. 그 중 치과 영역은 생활 습관이나 식습관 등에 의해 많은 영향을 받는다. 그리고 이 부분에 있어서, 장애아 본인만이 아니라 가족이라는 공동체의 습관이 미치는 영향이 매우 높다. 본 연구에서는 지역사회에 거주하는 장애아동을 대상으로 학부모의 식습관이나 구강관리 행태가 장애아동의 구강건강에 어떠한 영향을 미치는지, 장애아동의 식습관이나 구강관리 행태가 장애아동의 구강건강에 어떠한 영향을 미치는지를 알아보고 결과적으로 학부모의 식습관이나 구강관리 행태가 장애아동의 구강건강에 어떠한 영향을 미치는지를 알아보고자 한다. 본 연구는 충청북도 청주시에 소재한 장애인복지시설인 혜원장애인 복지관에 방문하는 장애아동을 대상으로 197부를 설문조사·분석을 실시하였다. 학부모의 식습관과 아동 구강상태는 신선식품일 때, 인스턴트식품보다 아동의 구강건강에 더 좋았다. 또한 장애아동의 식습관과 아동 구강상태는 신선식품일 때, 인스턴트식품보다 아동의 구강건강에 더 좋았다. 결과적으로 아동의 구강건강에 도움이 되는 학부모의 식습관은 주식 또는 간식을 인스턴트 보다는 신선식품을 섭취하게 해 주는 것이 좋을 것으로 본다.

간호 분야에서의 사용자 경험 조사를 통한 의료제품 및 의료서비스 혁신방안 모색

안이레 충북대학교 2021 국내석사

본 연구는 간호 분야에서의 사용자 경험 조사를 통한 의료제품 및 의료서비스 혁신방안을 모색하고자 시도되었다. 간호 분야에서의 사용자 경험 조사를 위해 간호영역을 크게 4가지로 분류하여 ‘투약 간호영역’, ‘배설 간호영역’, ‘감염 및 안전 간호영역’, ‘기타(종합) 간호영역’의 업무량 및 시간 소모가 많은 간호행위 등을 파악하기 위한 사전설문지를 개발하였다. 본 연구에서는 간호사 25명이 작성한 사전설문지를 바탕으로, 2019년 11월부터 12월까지 11차례에 걸친 심층인터뷰와 2021년 4월에 1차례의 추가 심층인터뷰를 진행함으로써 간호영역별 의료제품 및 의료서비스의 충족되지 않은 의료수요를 파악하고자 시도하였고, 수집된 자료를 분석하여 결과를 도출하였다. 연구 결과는 각 간호영역별 사용자 경험 조사 결과로 정리하였으며, 고찰에서는 ‘간호영역별 키워드 분류’, ‘간호영역별 시간소모가 많은 간호행위’, ‘간호영역별 의료제품 및 의료서비스 혁신 아이디어’, ‘간호영역별 혁신방안 모색’이라는 4개의 주제를 도출할 수 있었다. 본 연구를 통해 간호 분야에 혁신이 필요한 의료제품과 의료서비스가 많다는 점과 간호사의 고충을 알게 되는 귀한 시간이었다. 본 연구의 결론에서 제시한 의료제품 및 의료서비스의 혁신방안을 실현하기 위해서는 각 이해관계자별로 각자의 역할을 충실하게 수행하고 함께 노력할 때 우리나라의 의료제품과 의료서비스의 혁신이 빨라질 것을 기대할 수 있다. This study was attempted to explore ways to innovate medical products and healthcare services through user experience surveys in the nursing field. In order to investigate user experience in the nursing field, the nursing field was divided into four major categories, "nursing in medication administration", “nursing in elimination", "infection and safety nursing", and "other (comprehensive) nursing". Then, pre-questionnaires were developed to identify the workload and time-consuming nursing activities of the four sectors. In this study, based on pre-questionnaires filled out by 25 nurses, 11 in-depth interviews were conducted from November 2019 to December 2021 and one additional in-depth interview in April 2021. The study attempted to identify the unmet medical needs of medical products and medical services in each of the four nursing areas, and the results were derived by analyzing the collected data. The results of the study were organized as a result of user experience surveys in each nursing area. In reviewing the results, four themes were able to be derived: ‘Classification of keywords by nursing area,’ ‘Time-consuming nursing practices in each area of nursing,’ ‘Ideas for innovation of medical products and medical services by each nursing areas.’ ‘Searching for innovative measures for each area of nursing’. Through this study, it was a valuable time to learn that there were many medical products and medical services that require innovation in the field of nursing and the difficulties of nurses. In order to realize innovation measures for medical products and medical services, presented in the conclusion of this study, it can be expected that innovation of medical products and medical services in Korea will accelerate when each stakeholder faithfully fulfills their respective roles and works together.

급성 심장정지 환자의 전원에 영향을 미치는 환자 및 지역적 요인

홍송은 충북대학교 2019 국내석사

급성 심장정지 환자의 병원 간 이송에 영향을 미치는 요인을 확인하여, 연구 결과를 통해 급성 심장정지 환자의 생존율 향상을 위한 예방과 국내 응급의료 이송체계 제도 개선에 대해 제안하고자 본 연구를 진행하였다. 질병관리본부의 2015~2016년 급성 심장정지 조사를 대상으로 급성 심장정지 환자의 병원 간 이송에 영향을 주는 환자 개인의 특성과 구급 및 응급의료 지역적 특성을 상관분석을 실시하고, 상관분석을 통해 관련성이 있다고 확인된 변수를 로지스틱 회귀분석을 통해 전원에 영향을 미치는 요인을 분석하였다. 급성 심장정지 환자의 병원 간 이송과 환자 요인과의 상관성을 비교하였을 때, 성별, 나이, 목격 여부, 발생 장소, 병원 도착 전 심폐소생술 시행 여부, 병원 도착 전 자발순환 회복 여부, 심전도 소견에서 유의한 확률을 보였고, 지역 요인에서는 구급차 보유 대수, 응급의료기관 수, 응급실 전담 전문의 수가 유의한 확률을 보여 병원 간 이송과 상관성이 있다고 확인되었다. 이를 통해 급성심장정지 환자의 병원 간 이송에 영향을 주는 요인을 확인하기 하였으며, 나이는 60세 이상인 경우 오즈비 0.636으로 나이가 많을수록 전원을 보낼 확률이 감소하였으며, 목격 여부에서 목격됨이 오즈비 1.834로 목격된 환자에서 전원을 보낼 확률이 증가하였고, 병원 도착 전 자발순환 회복 여부에서 자발순환 회복됨이 오즈비 5.192로 자발순환 회복된 경우에서 전원을 보낼 확률이 증가하였으며, 심전도 소견이 제세동 가능 리듬이 오즈비 1.129로 제세동 가능 리듬에서 전원을 보낼 확률이 증가하였으며, 응급의료기관 수는 오즈비 1.522로 응급의료기관 수가 많을수록 전원을 보낼 확률이 증가하였고, 응급실 전담 전문의 수는 오즈비 1.148로 응급실 전담 전문의 수가 많을수록 전원을 보낼 확률이 증가함을 확인하였다. 급성 심장정지 환자의 병원 간 이송에 영향을 주는 환자 및 지역적 요인을 확인한 결과 급성 심장정지 환자가 목격된 경우, 병원 도착 전에 자발 순환이 회복된 경우, 심전도 소견이 제세동 가능 리듬인 경우, 응급의료기관 수가 많은 지역의 경우, 응급실 전담 전문의 수가 많은 지역의 경우에 병원 간 이송을 보낼 확률이 더 높은 것을 확인하였다. This study was conducted to identify factors that affect the inter-hospital transfer of out of hospital cardiac arrest patients and to propose methods of prevention to improve the survival rate of out of hospital cardiac arrest patients and methods to improve the emergency medical transfer system in Korea through research results. Based on out of hospital cardiac arrest patient surveys conducted by the Korea Center for Disease Control and Prevention from 2015 to 2016, correlation analysis was conducted on the personal characteristics of patients and the regional characteristics of first-aid and emergency care, which affect the inter-hospital transfer of out of hospital cardiac arrest patients, and of variables confirmed to have correlations through correlation analysis, factors that affect transfer were analyzed through logistic regression. When correlations between the inter-hospital transfer of out of hospital cardiac arrest patients and patient factors were compared, significant probabilities appeared with gender, age, whether there was a witness, the location of the occurrence, pre-hospital bystander CPR, pre-hospital ROSC, and electrocardiogram findings and with regional factors, significant probabilities appeared with the number of prepared ambulance vehicles, the number of emergency medical treatment centers, and the number of emergency room specialists, showing correlations with inter-hospital transfer. Through this, factors that affect the inter-hospital transfer of out of hospital cardiac arrest patients were verified and with those over the age of 60, the probability of transfer decreased as age increased with a odds ratio of 0.636 and with whether there was a witness, probabilities of transfer increased for witnessed patients with a odds ratio of 1.834, and with pre-hospital ROSC, probabilities of transfer increased for patients who had ROSC with a odds ratio of 5.192, and with ECG findings of shockable rhythms, probabilities of transfer increased for shockable rhythms with a odds ratio of 1.129, and with the number of emergency medical treatment centers, probabilities of transfer increased as the number of emergency medical treatment centers increased with a odds ratio of 1.522, and with the number of emergency room specialists, probabilities of transfer increased as the number of emergency room specialists increased with a odds ratio of 1.148. Verifications of patient and regional factors that affect the inter-hospital transfer of out of hospital cardiac arrest patients showed that probabilities increased when the out of hospital cardiac arrest was witnessed, when there was pre-hospital ROSC, when ECG findings show shockable rhythms, when the region has a large number of emergency medical treatment centers, and when the region has a large number of emergency room specialists.

한국 A형 및 C형 간염 발생의 지역적 변이와 추세

강미화 충북대학교 2023 국내박사

A형 간염은 폭발적 발생 양상과 성인기 감염 시 심각한 증상으로 사망까지 초래할 수 있고, C형 간염은 만성화율과 간경화, 간암 유발 가능성이 높아 적극적인 예방 및 치료 정책이 필요하다. 이러한 A형 및 C형 간염의 효과적인 관리를 위해서는 정확한 시군구 단위의 구체적인 고위험 지역과 고위험 집단을 파악할 필요가 있으나 국내에서는 2020년을 포함한 최신의 감염병 전수 데이터로 분석한 연구가 이루어진 바 없다. 이에 본 연구에서는 2011년부터 2020년까지 국민건강보험 데이터를 활용하여 감염병 발생 추세와 위험집단을 파악하였고, 지리정보시스템을 이용하여 시군구 단위까지 전국적인 분포를 시각화하고 위험지역을 분석하였다. 또한 동일한 연도의 지역사회건강조사 데이터를 매칭 후 다변량 회귀분석으로 A형 및 C형 간염 발생과 관련한 지역적 특성을 밝히고자 하였다. 분석 결과 10년 간 신규 발생 총 진료 건수는 A형 간염 82,910건, C형 간염 489,231건, 10만 명당 발생률은 A형 간염 15.5명, C형 간염 89.6명이었다. 성별에 따른 A형 간염은 남성(55.9%)에게 C형 간염은 여성(51.3%)에게 더 많이 발생하였다. 연령대별로는 A형 간염은 30대(33.3%)가 가장 높고 20-40대에서 78.0%가 발생하였고, C형 간염은 70대(30.0%)가 가장 높고 60대 이상 노년층에서 64.9%가 발생하는 것으로 분석되었다. 각 간염의 발생 추세를 살펴보면 A형 간염은 특정한 추세 없이 우발적으로 발생하며 2011년과 2019년에 대유행이 있었다. 반면에 C형 간염은 10년 동안 지속적으로 높은 발생률을 보였으며 2016년부터 2020년까지는 소폭 감소하는 추세를 보였다. A형 간염의 대유행 시 연령대를 분석한 결과, 1971-1991년 출생 인구집단이 가장 높은 발생률을 보이는 고위험 집단임을 확인하였다. A형 간염은 발생의 지역적 일관성이 없었지만, C형 간염은 높은 발생률을 보이는 지역에서 계속해서 높은 발생률을 보였다. C형 간염의 10만 명당 발생률은 부산광역시(209.7명), 전라남도(159.4명), 경상남도(138.6명) 순으로 매년 높은 발생률을 나타내었으나 시군구 분포를 확인한 결과 시도 데이터로는 구체적으로 확인하기 어려웠던 전라북도 지역의 순창(656.6명)이 전국적으로 가장 높은 발생률을 보이는 것과 충청남도 지역의 금산군(326.0명)과 청양군(256.1)도 고위험 지역인 것을 파악하였다. A형 간염 발생에 영향을 주는 지역사회 특성은 현재 흡연율, 고혈압 진단 경험율, 식사 전 손 씻기 실천율이었고, C형 간염 발생에 영향을 주는 지역사회 특성은 식사 전과 대변 후 손 씻기 실천율, 그리고 인구 천 명당 의사 수로 나타났다. 본 연구는 전 국민을 대상으로 한 전수자료를 이용하여 장기간에 걸쳐 발생률을 추정하여 대표성이 높은 분석 결과를 제시하였다는 데 그 의의가 있다. 본 연구에서 밝혀진 고위험 세대와 시군구 단위의 고위험 지역에 대한 정보는 감염병의 예방과 효과적인 관리 대책을 수립하는 데 도움이 될 것으로 기대한다. Hepatitis A and C are serious diseases. Hepatitis A can cause severe health problems and even death. Hepatitis C often becomes a chronic illness, leading to serious issues like liver cancer. Because of this, it's crucial to prevent and treat these diseases effectively. To manage these diseases, we need to understand who is most at risk and where these diseases are most common. But until now, no study in South Korea used the latest data to look at these diseases in detail. This study fills that gap. The study looked at health insurance data from 2011 to 2020. It analyzed how many people got Hepatitis A and C, identified where the diseases were most common, and who was most at risk. It is also used geographic information to see how these diseases spread in different cities and counties. The results showed that in the last 10 years, there were 82,910 new cases of Hepatitis A and 489,231 of Hepatitis C, with an incidence rate of 15.5 per 100,000 for Hepatitis A and 89.6 per 100,000 for Hepatitis C. Men were more likely to get Hepatitis A, while women were more likely to get Hepatitis C. Hepatitis A occurred more frequently in men (55.9%) while Hepatitis C was more common in women (51.3%). By age, Hepatitis A had the highest incidence in people in their 30s (33.3%) and 78.0% occurred in those aged 20-40, while Hepatitis C was most prevalent in those in their 70s (30.0%) and 64.9% of cases occurred in those aged 60 and above. When examining the trends of each type of hepatitis, Hepatitis A occurred sporadically without a specific trend, with epidemics occurring in 2011 and 2019. On the other hand, Hepatitis C consistently showed a high incidence rate over the 10-year period, but displayed a slight decline from 2016 to 2020. Analysis of the age group during the Hepatitis A epidemic confirmed that the population group born between 1971 and 1991 had the highest incidence rate and was thus identified as a high-risk group. While Hepatitis A did not show geographic consistency in occurrence, Hepatitis C consistently displayed high incidence rates in the same areas. The incidence rate of Hepatitis C per 100,000 was highest in Busan (209.7), Jeonnam (159.4), and Gyeongnam (138.6), but when examining the distribution at the city and county level, Sunchang in Jeonbuk region (656.6) had the highest national incidence rate, with Geumsan county (326.0) and Cheongyang county (256.1) in the Chungnam region also identified as high-risk areas. The community characteristics that influenced the occurrence of Hepatitis A were smoking rate, hypertension diagnosis rate, and the rate of handwashing before meals, while those influencing Hepatitis C were the rate of handwashing before meals and after defecation, and the number of doctors per thousand people. The significance of this study lies in its use of census data from the entire population to estimate incidence rates over a long period, providing a highly representative analysis. The information on high-risk generations and high-risk areas at the city and county level identified in this study is expected to assist in the prevention of infectious diseases and the development of effective management strategies.

1상 임상시험 관리 매뉴얼 개발

김선영 충북대학교 2018 국내석사

신약 개발은 인간의 건강과 경제적 이익을 가져 왔다. 임상시험은 신약개발에 필수적인 과정으로 임상시험에는 여러 단계가 있으며 특히 1상 임상시험은 사람에게 새로운 약물을 투여하는 첫 번째 단계이다. 따라서 신약의 위험성으로 인하여 입원 환자 서비스, 간호 요원, 첨단 장비가 필요하며 또한 할당 된 자원을 효율적으로 사용할 수 있는 관리 시스템이 있어야한다. 그러나 1상 임상시험이 중요함에도 불구하고 현재는 교육을 위한 적절한 교재가 없다. 이런 필요에 따라 경영활동 과정인 계획, 조직화, 지휘화 및 통제화의 4개 부분으로 나누어 진 관리 매뉴얼이 개발되었다. 이 관리매뉴얼 개발에는 1상 임상시험의 전문가인 총 7명의 임상시험 코디네이터와 임상연구 간호사가 참여하였다. 또한 1상 임상시험 관리 매뉴얼의 필요성을 확인하기 위해 임상시험 코디네이터, 임상연구 간호사, 임상시험모니터요원에게 설문조사를 하였다.   본 매뉴얼의 특징은 전문가가 집필하였고, 그들의 다양한 임상시험 경험을 바탕으로 기술이 되어있어 실제 1상 임상시험의 실무를 수행하는데 가장 근접한 매뉴얼이다. 그러므로 이 관리매뉴얼은 1상 임상시험을 처음으로 수행하는 임상시험 코디네이터, 임상연구 간호사와 임상시험모니터요원에게 지침서가 되며, 1상 임상시험의 관리자에게는 가이드라인으로 활용될 것이다. 또한 의뢰자와 임상시험수탁기관에게는 1상 임상시험 실시기관을 선택하는데 기준을 제시하고, 나아가 우리나라의 1상 임상시험의 질을 향상시키는데 도움이 될 수 있다. The development of new drugs has brought about human health and economic benefits. Clinical trial is an essential process in the new drug development. There are several stages of the clinical trial, particularly Phase I is the first step in administering new drugs to human subjects. Therefore, due to the existence of the risk of the new drug, it is necessary to have inpatient services, nursing staffs, and advanced equipments, as well as the management system to efficiently use the allotted resources. However, despites the importance of the Phase I trials, there are currently no educational materials available. With the needs, the management manual was developed which is divided into four parts: planning, organization, command, and control. A total of 7 people participated in the management manual, including Clinical Research Coordinators (hereinafter “CRC”), and Clinical Research Nurses (hereinafter “CRN”), who had experience in phase I clinical trials. In addition, I surveyed CRC, CRN and CRA to determine the need for Phase I clinical trial management manual. The features of this manual were written by the experts and based on their various clinical experiences. It is the most comprehensive manual that can be applied in real settings. Thus, this management manual could act as a guideline to CRC, CRN, Contract Research Organization (hereinafter “CRO”), and administrators who are performing the Phase I clinical trials for the first time. It may also help the sponsor and the CRO to set standards when selecting the Phase I clinical trials unit and to improve the quality of Phase I clinical trials in the Republic of Korea.

병원원가계산시스템 개선방안 도출연구 : C병원 내시경원가 분석사례를 기반으로

김민정 충북대학교 2019 국내석사

The purpose of this study is to develop an activity - based costing system for case hospitals. In order to continuously grow and develop the hospital, it is necessary to establish a reasonable cost accounting system to ensure the right amount of medical fee for the outward, and to rationalize management internally. In this respect, the number of hospitals that set up the activity-based cost system is increasing, but it is difficult to grasp the cost of the hospital due to the diversity of medical services and the complexity of the telephone process for costing. C Hospital, in 2016, the activity based costing system has been introduced and operated for the first time, and efforts are being made by the agency to ensure the reliability of the costing results and use them appropriately. The purpose of this study is to develop the activity based costing system for C Hospital through case analysis of endoscopic costing process. Through these case studies, 11 problems were derived and suggestions for improving the problems were suggested by improving the computer system and improving the way of working. In this study, it is meaningful to improve the reliability of the activity based costing system of C hospital, and to calculate the cost calculation result with credibility as the management information, and to make the management rationalization based on the continuous growth and development of the hospital.

지역별 심정지 발생의 변이와 관련 요인에 관한 연구

김진구 충북대학교 2016 국내석사

The out-of-cardiac arrest is a critical health issue in Korea. The number of sudden cardiac arrest are on the increase every year. As the cardiac arrest occurrence varies depending on the region, it is critical to prevent the cardiac arrest from the level of local community. The purpose of this study is to find out the regional variation of the occurrence of disease-specific cardiac arrest and the variation factors. We studied the Out-of-Hospital Cardiac Arrest Surveillance of Korea Centers for Disease Control and Prevention and data of community health survey for the years of 2010, 2011, 2012 and 2013. We established the data set for cardiac arrest occurrence, health behaviors and morbidity that we got from 245 administrative districts. The regional variable analysis, correlation analysis and multiple regression analysis were used. The analysis findings showed that the regions having higher level of smoking or educational level showed the higher level of cardiac arrest occurrences and that in the people in the age of 19 ~ 65, the regions having less income or lower education level have higher cardiac arrest occurrence rates. In the group of people in the age of 65 or above, the regions having higher smoking rate, higher diabetes medication rate, higher diagnosis rate of dyslipidemia, lower educational level or higher income level showed the higher cardiac arrest occurrence rate. The findings are similar to the results from prior studies. The findings of the study have the implications that the cardiac arrest prevention project for lowering the cardiac arrest occurrence shall be conducted based on the regional characteristics and age-specific characteristics including the health behaviors, morbidity and regional characteristics.