Economic burden of otitis media and a survey of physicians for its practice and claim codes in Korea

천병철,손우연,정원주,이환종 대한의사협회 2013 대한의사협회지 Vol.56 No.1

Otitis media (OM) is one of the most common pediatric infectious diseases. The burden of OM is known in many countries, but data for Korea has not been collected. The primary objective of this study was to evaluate the disease burden of OM in both children and adults. The Health Insurance Review and Assessment database study was analyzed to estimate the clinical and economic burden of OM and acute OM (AOM) for 2004. OM was defined as all cases coded H65,H66, or H67 and AOM cases coded H65, H65.0, H65.1, H65.9, H66, H66.4 or H66.9. For AOM,repeated visits within 30 days were considered to be one episode. Age specific incidence, and direct and indirect costs were estimated. A survey on pediatricians and otolaryngologists who most frequently diagnosed OM was carried out. The objective was to evaluate the accuracy of the claims made for OM and to examine the diagnosis and treatments of OM. A total of 5,964,587claims for OM and 2,924,532 AOM episodes were reported. The incidence of outpatients presenting AOM was 60.9/1,000. The incidence of AOM was highest in children aged 1 year (736.9/1,000). The overall hospitalization rate due to AOM was 2.8/10,000, with a peak of 29.4/10,000 (1 year). The total cost incurred by AOM in Korea was estimated to be around 606.3billion Korean won (KRW; 1,000 KRW is approximately US$1.00). The total cost of admissions was approximately 22.9 billion KRW, and the average cost of admission per person was about 1,690,000 KRW in a year. The cost of outpatient visits was 583.4 billion KRW, and 199,000 KRW per person. According to a survey of pediatricians and otolaryngologists on the accuracy of the OM diagnostic code, treatment, and prescription habits, the first-line diagnosis of AOM seemed to be fairly accurate. OM, including AOM, causes a considerable clinical and economic burden in Korea.

通貨總量의 經濟成長 및 인플레이션 豫測力 提高에 관한 硏究

천병철 한국은행 2000 經濟分析 Vol.6 No.1

본 연구에서는 최근의 금융의 자유화 및 개방화 등으로 통화총량을 이용한 거시경제 전망의 精度가 저하된 점을 주시하고 통화총량과 경제성장 및 인플레이션간의 관계를 보다 안정적으로 예측할 수 있는 새로운 방법을 모색하였다. 이를 위하여 최근 계량분석에서 많이 적용하고 있는 시간변화요소를 반영한 switching regression 모형과 칼만필터링 時變母數模型을 이용하였으며 아울러 이 방법들의 상대적 예측력을 평가하기 위해 OLS 모형도 병행하여 사용하였다. 실증분석 결과에 의하면 switching regression 모형이나 칼만필터 시변모수모형이 기존의 OLS 모형보다 예측력 측면에서 우월한 것으로 나타났다. switching regression 모형에서는 MCT나 M3의 단일 계열보다는 M1, M2 및 MCT 또는 M3를 시간에 따라 적절히 변경(switching)한 시계열의 예측력이 높게 나타났다. 시변모수모형에서는 시간이 흐르면서 통화총량을 구성하는 항목들의 예측기여도가 변하고 있음을 보여주었다. 이러한 분석결관느 명목 GDP 및 인플레이션 예측에 있어 통화지표의 예측력을 보다 제고할 수 있는 여지가 있음을 시사하고 있다.

직장 건강증진사업 : Issues and Strategies 논점과 전략

천병철 서울大學校 保健大學院 1997 國民保健硏究所硏究論叢 Vol.7 No.2

Since the publication of the Lalonde Report in 1974, the concept of health promotion have been introduced into many health-related fields. In this report, he emphasized the self-imposed risls and environment as the determinants of major 5 diseases, and the change of the helath behavoir and environment would reduce the premature mortality from diseases. Health promotion programs have been developed within 3 main groups- schools, worksite, commuities - in USA. The employed persons are those at greatet risk for premature morbidity and mortality, those who occupies about 1/4 of whole population and those who makes social productivity. It is optimal to apply health promotion progam to worksite, because it is effective, easily accessible and even beneficial to both the employees and the employers. The examples of typical worksite health promotion programs are smoking cessation, hypertention control, nutrition, weight control, stress management, exercise and fitness and other assitance programs concernig alcohol, drugs and accident prevention. In other aspecs, these programs are too much individualized, not concordant with pre-existing occupational health system, restricted participation of the employees and lack of carefully performed cost-benefit analysis. In Korea, the problesm of worksite health promotion is more comples. The major proportion of the workers sork for small or very small worksites, and many of them for service industries. Less than half of the company have the worksite health manager. There are insufficient survey for the health needs of employees and emplyers, and many other problems- discordant with pre-existing system, lack of evoluations etc. It is need to concrete firm base to establish suitable worksite health promotion programs before imitating other contries's programs.

사람에서 조류인플루엔자 유행과 인플루엔자의 대유행

천병철 대한수의학회 2011 대한수의학회 학술대회발표집 Vol.2011 No.-

우리나라 감염병관련 법률 및 정책의 변천과 전망

천병철 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.6

The history of modern infectious disease control in Korea could be divided into 4 era by its characteristics; the Opening and Korean Empire era (1896-1910), Japanese Colonial Rule and US military government era (1910-1948), Korean government era before 2000 (1948-2000) and After 2000 (2000-present). In the Opening and Korean Empire era, the first form of communicable disease prevention act was issued in 1899, including the first 6 notifiable communicable diseases in Korea; cholera, smallpox, dysentery, diphtheria and epidemic typus. Before establishment of administrative department for infectious disease, Japanese Colonial Empire took the police power away and set the colonial sanitary police system in 1907. During the Japanese Colonial Rule, the sanitary police system was forcefully active not only to control the epidemics but also fortify the colonial governmentalism. But during the colonial era, the incidence of water-borne diseases like typhoid fever and dysentery had increased, and the respiratory diseases both diphtheria and tuberculosis also had increased. This forceful sanitary police system had influenced the communicable prevention act and health policy for over 50 years after the colonial era. In 1954 the Korean government proclaimed the communicable prevention act. Since then the government increased the number of national notifiable diseases and refined the related acts by public needs. In 2000, the communicable prevention act was fully amended to satisfy the modern public health principles not the sanitary policy rules. And the revised act named 'Infectious Diseases Control and Prevention Act' was proclaimed in 2010. The globalization, emerging and re-emerging infectious disease, climate change, change of health behavior, development information technology, unification of Korean peninsula would be the next challenges of infectious disease control and prevention in Korea.

절삭유 취급 근로자의 피부질환에 관한 연구

천병철,김희옥,김순덕,오칠환,염용태,Chun, Byung-Chul,Kim, Hee-Ok,Kim, Soon-Duck,Oh, Chil-Hwan,Yum, Yong-Tae 대한예방의학회 1996 예방의학회지 Vol.29 No.4

절삭유의 사용과 피부질환의 관계를 알아보기 위하여 한 자동차공장의 엔진 및 구동부서 근로자 1,004명을 대상으로 피부 이상 증세에 대한 기초설문조사를 실시하여 응답을 해준 근로자 667명을 대상으로 분석 및 피부과적 검진을 실시하였다. 또한 절삭유의 노출 정도를 알기 위한 방법으로 공기 중 오일 미스트를 측정하였다. 이 조사의 결과를 요약하면 다음과 같다. 1. 공기 중 오일미스트는 3개 부서로 나누어서 측정 하였는데, 전체 52건의 측정건수 중에서 8시간가중 평균 기준치인 $5mg/m^3$을 넘는 건수는 9건(17.3%)이었고, 로그정규분포상에서 95% 신뢰한계의 전체 상한치는 기준치 미만이었다. 2. 조사한 부서는 엔진가공부(258명), 가솔린 엔진조립부(210명), 디젤엔진조립부(96명), 구동부 가공반(86명), 구동부 조립반(17명)의 5개 부서였으며, 조사한 667명의 평균 나이는 34.5세였고, 근무연수의 중앙값은 7년 7개월이었다. 3. 이들 부서 중 엔진가공부와 구동부 가공반(A군)은 절삭유를 공정상 많이 사용하는 부서로 근로자 344명 중 298명 (86.6%)이 한 가지 이상의 절삭유를 사용하고 있는 반면, 가솔린엔진 조립부, 디젤엔진 조립부, 구동부 조립반의 근로자 323명(B군) 중에는 31명 (9.1%)만이 절삭유를 사용하고 있었다. 4. 피부 이상 증세의 경험자 227명 중 213명에 대하여 피부과전문의의 진찰을 시행하였는데, 이중에 172명이 검진당시 증세를 호소했는데, 1인당 평균 호소증세 건수가 1.5건 정도였다. 가장 많은 증세는 가려움증(32.5%), 구진(21.6%), 인설(15.7%), 소수포(12.5%), 반점(9.4%)의 순서였다. 5. 검진을 받은 근로자 231명 중 정상소견이나 뚜렷한 병변이 없는 사람으로 분류된 경우는 53명이었고, 나머지 160명에서 피부과적 질환이 발견되었다. 가장 많은 것은 접촉 피부염으로 전체 질환자 중 92명 (57.5%)을 차지하였고, 이들 중에는 여드름이나 낭포염 등 기타 다른 피부질환을 동반한 경우가 23명 (25%) 이었다. 기타 낭포염, 여드름만 있는 경우도 각각 9명(5.6%), 8명(5.0%)이었으며 , 각질화와 색소 이상도 1명 씩 발견되었다. 기타의 수부 습진은 비특이성 수부습진으로 분류되었는데 이들은 47명이었다. 6.피부질환이 있다고 진단받은 160명에서 발견된 피부과적 이상부위는 1인당 1.3부위였다. 이상이 발견된 부위는 손바닥(27.6%), 손가락과 손톱(22.7%), 상박부(16.0%), 손등(11.8%), 손가락 사이(10.3%)의 순이었고, 이들 수부 및 상박부위의 이상이 전체 이상의 약 88.7%였다. 7. 전체 피부질환의 유병상태는 각 부서별로 차이가 많았는데, 특히 접촉 피부염의 경우 엔진가공부는 1,000명당 213명, 가솔린엔진 조립부는 1,000명당 29명, 디젤엔진 조립부는 1,000명당 73명이었고, 구동부 가공반은 1,000명당 267명, 구동부 조립반은 1,000명당 59명으로 부서별로 차이가 매우 켰다. 이러한 경향은 절삭유 사용에 따라서 특히 수용성 절삭유만 사용하는 군과 두 종류의 절삭유를 모두 사용하는 근로자에서 마찬가지로 높게 관찰되었다. 8. 감별진단이 필요하다고 판단된 접촉 피부염 환자 49명은 첩포 검사를 시행하였다. 첩포 검사 결과, 기본 표준시료에 양성이 나타난사람이 12명, 기본표준시료와 오일시료에 모두 양성이 나타난 사람 3명, 그리고 오일 시료에만 양성이 나타난 사람 3명이 있었고, 기본 표준시료와 유기용제시료에 양성이 나타난 사람, 유기용제 시료에만 양성이 나타난 사람이 각각 1명 있었다. 9. 전체 피부질환의 유무에 대하여, 근 We investigated the 1,004 workers who worked in a automobile factory to study the epidemiologic characterists of dermatoses due to cutting oils. Among the workers, 667(66.4%) answered the questionaire. They are belong to 5 departments of the factory-the Engine-Work(258 workers), Gasoline engine Assembly(210), Diesel engine Assembly(96), Power train Work(86), Power train Assembly(17). We measured the oil mist concentration in air of the departments and examined the workers who had dermatologic symptoms. The results were follows; 1) Oil mist concentration ; Of all measured points(52),9 points(17.2%) exeeded $5mg/m^3$- the time-weighed PEL-and one department had a upper confidence limit(95%) higher than $5mg/m^3$. 2) Dermatologists examined 213 workers. 172 of them complained any skin symptoms at that time - itching(32.5%), papule(21.6%), scale(15.7%), vesicle(12.5%) in order. The abnormal skin site found by dermatologist were palm(29.3%), finger & nail(24.6%), forearm(16.2%), back of hand(8.4%) in order. 3) As the result of physical examination, we found that 160 workers had skin diseases. Contact dermatitis was the most common; 69 workers had contact dermatitis alone(43.1%), 11 had contact dermatitis with acne(6.9%), 10 had contact dermatitis with folliculitis(6.3%), 1 had contact dermatitis with acne & folliculitis, and 1 had contact dermatitis with abnormal pigmentation. Others were folliculitis(9 workers, 5.6%), acne(8, 5.0%), folliculitis & acne (2, 1.2%), keratosis(1, 0.6%), abnormal pigmentation (1, 0.6%), and non-specific hand eczema (47, 29.3%). 4) The prevalence of any skin diseases was 34.0 pet 100 in cutting oil users, and 13.3 per 100 in non- users. Especially, the prevalence of contact dermatitis was 23.0 per 100 in cutting oil users and 23.0 per 100 in non-users. 5) We tried patch test(standard serise, oil serise, organic solvents) on 49 patients to differentiate allergic contact dermatitis from irritant contact dermatitis and found 20 were positive. 6) In a multivariate analysis(independant=age, tenure, kinds of cutting oil), the risk of skin diseases was higher in the water-based cutting oil user and both oil user than non-user or neat oil user(odds ratio were 2.16 and 2.78, respectively). And the risk of contact dermatitis was much higher at the same groups(odds ratio were 5.16 and 6.82, respectively).

의사결정나무분석 기법을 활용한 세균성이질의 환례정의

천병철 한국보건통계학회 2001 보건정보통계학회지 Vol.26 No.1

Shigellosis is an acute, infectious, inflammatory enteritis of humans. It is often clinically manifested by the dysentery syndrome(frequent bloody-mucoid stool, tenesmus, abdominal cramp). But the clinical signs and symptoms of shigellosis by S. sonnei were known as being variable and hardly defined. For this reason, There were very few studies about the case definition of shigellosis. Data mining techniques including decision tree analysis are newly developed analytical algorithms to explore the database and to discover association rules, risk factors and predictive factors. In this study, decision tree analysis technique was applied to the epidemiologic data to define the shigellosis by clinical signs and symptoms. Standard questionnaires were collected and bacteriological culture by rectal swaps were performed to all cases in two shigellosis epidemics-one for high school students and the other for elementary students. The characteristics of diarrhea were quite different from classical dysentery, and the blood -mucous type was under 5% in both group. Distributions of first symptom, maximum diarrheal number in a day and the type of diarrhea were very similar to each other groups. But the diarrheal duration of elementary students were significantly longer than those of high school students. Frequencies of abdominal cramp, headache and febrile sense were significantly high than those of high school students. As a result of decision tree analysis showed the febrile sense, maximum diarrheal number in a day, abdominal discomfort and duration of diarrhea were selected significant variables to predict the bacteriological positiveness in elementary school students. The sensitivity and specificity of this results were 51% and 97% in high school students; 91% and 79% in elementary school students respectively.

재난의 정의, 분류 및 공중보건학적 의의

천병철 대한의사협회 의료정책연구소 2015 의료정책포럼 Vol.12 No.4

중동호흡기증후군 유행 시 밀접접촉자의 정의와 관리방안: 2015년 유행의 반성과 교훈

천병철 대한의사협회 2015 대한의사협회지 Vol.58 No.8

Middle East respiratory syndrome (MERS) is an emerging zoonosis caused by the novel MERS corona virus isolated in 2012. Most MERS cases have been reported from Arab countries of the Middle East, including Saudi Arabia, United Arab Emirates, Qatar, and Jordan. There have been a few imported cases in many countries, but the exception is Korea, which reported 186 confirmed cases originating from one imported case in a two-month outbreak in 2015. There are many lessons to be learned from the MERS outbreak in Korea, among them, management of contacts. The definition of “close contact” used by the Korean Centers for Disease Control and Prevention (KCDC) for MERS response was not clear and not compatible with the definition of the World Health Organization. This incorrect definition allowed the KCDC make serious mistakes in contact tracing and management in the early epidemic stage of MERS. After the rapid expansion of the outbreak, the KCDC redefined a “close contact” according to the definition of the US CDC. The total number of close contacts was 16,693 in this outbreak, and they were all forced to conduct a self-quarantine for 14 days after the last contact with a MERS patient. It was not clear whether self-quarantine of close contacts was effective to control the outbreak. Given the lack of prepared guidelines or a social support system for them, these measures for the massive number of asymptomatic contacts caused a great deal of confusion in the field A clear response guideline is needed for contact management based on robust evidence from this MERS epidemic in Korea.

[주제발표 1] 감염병 위기대응체계 개선

천병철 대한의사협회 의료정책연구소 2015 의료정책포럼 Vol.13 No.3