보건의료체계 지속가능성의 필수 조건들

배종면,Bae, Jong-Myon 제주대학교 의과학연구소 2019 The Journal of Medicine and Life Science Vol.16 No.2

While sustainability is seen in terms of social, economic and environmental dimensions, securing longterm financial costs and planning long-term strategic perspective among policy-makers are needed to maintain a healthcare system sustainability. Thus, the networking and cooperation between policy makers and health care workers should be tightened and strengthened in order to keep and enhance the healthcare system sustainability.

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea

배종면,Bae, Jong-Myon The Korean Society for Preventive Medicine 2017 예방의학회지 Vol.50 No.4

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

건강한 한국 성인남성의 자가약물복용력에 따른 간기능 장애 발생여부 조사

배종면,박병주,이무송,김동현,신명희,안윤옥,Bae, Jong-Myon,Park, Byung-Joo,Lee, Moo-Song,Kim, Dong-Hyun,Shin, Myung-Hee,Ahn, Yoon-Ok 대한예방의학회 1996 예방의학회지 Vol.29 No.4

연구배경 : 약물복용에 관한 엄격한 규제가 없는 국내 의료현실상, 각종 건강에 관련된 약물이 범람하고 있어 약물 오 남용에 따른 심각한 약물부작용의 발생 가능성이 클 것으로 추정된다. 이에 건강한 성인 남성에서 영양제, 한약을 포함한 자가약물복용에 따라 간 기능 장애를 유발하는지를 코호트 내 환자-대조군 연구로 알아보았다. 방법 : ' 서울코호트' 대상자 중 (1)1990년도 정기 건강검진의 혈청결과상 HBsAg이 음성이면서 AST, ALT 모두 40 IU/L 이하인 대상자 (2) 1990년도 입원진료청구 전산자료상 간질환을 포함한 각종 질병으로 수진받은 적이 없는 자 (3)설문서 응답내용상 1991년 한해 동안 각종 질병이 발생되어 해당 약물을 복용한 적이 없는 자 (4)1992년도 정기 건강검진상 종합소견이 정상이면서 혈청검사상 HBsAg 음성인 자로 국한하여 본 연구를 위한 새로운 코호트를 구축하였다. 2년간의 추적조사 결과 1992년도 검사치상 AST/ALT 모두 40 IU/L 이상이면서 1990년도 AST/ALT에 비하여 100%이상 상승한 경우를 '간효소치 상승군(case group)'으로 정하였고, 반대로 1992년도 검사치상 AST/ALT 모두 40 IU/L 미만이면서 1990년도 ALT/ALT 에 비하여 상승 정도가 100% 미만인 경우를 '대조군(control group)'으로 하여, 약물복용과의 관련성을 카이자승법과 로지스틱 회귀법으로 알아보았다. 결과 : '간기능치 상승군(n=30)'은 대조군(n=2,625)' 에 비하여 44세 이하가 많았고, 경제수준이 높았으며 보다 비만하였으나 교육수준, 직업, 가족력, 수술력, 방사선 촬영력, 침구이용력, 흡연 및 음주습관에서 차이가 없었다. 약물복용에 있어서는 간장제와 한약복용은 차이가 없었으나, 스쿠알렌, 알로에 등의 건강보조식품 복용력은 '간기능치 상승군'에서 유의하게 많았다. 단변수 분석에서 유의성을 보인 변수들을 보정하여 보았을 때도 건강보조식품 복용력은 여전히 통계적 유의성을 잃지 않았다. 결론 : 본 연구결과는 건강인이라 하더라도 '건강보조식품'의 임의 복용은 간기능 장애를 유발할 가능성이 있다고 보아진다. 따라서 현재 '건강보조식품'의 사용이 급증하는 추세 속에서 치료제가 아닌 보조식품으로써의 '건강보조식품'이라 하더라도 장기간 임의 복용에 따라 어떤 부작용이 얼마나 발생할 것인지에 대한 연구가 향후 이루어져야 할 것으로 판단된다. Background: Korean people could abuse healthy foods as well as medications, which might cause serious side effects. The aim of this study was elucidating liver dysfunction due to the self-medications of hepatotonics, healthy foods and herb medications by nested case-control study. Methods: Study subjects were drawn from male members of Seoul Cohort Study who were recruited by self-administered structured questionnaire survey through mailing to the healthy men between the age of 40 and 59 years through the program of biennial health check-up offered by Korea Medical Insurance Corporation(KMIC). The liver dysfunction was defined as the level of serum AST and ALT above 40 IU/L and increased in more than one hunderd per-cent during the 2 year follow-up period. To estimate the odds ratio between self-medication and liver dysfunction after controlling for potential confounders, logistic regression was performed. Results: During the follow-up period, 30 members were identified to fit into case criteria and 2,625 members were selected as control. In logistic regression analyses, history of healthy foods intake, age under 45 years, obesity, and habit of regular exercise were significantly associated with liver dysfunction. The following factors exhibited no statistical significance: intake of hepatotonics, of herb medicine; history of disease in family, of operation, and of radiologic examination; smoking habits and drinking amounts. Conclusion: The significant association between the intake of healthy foods and the liver dysfunction illustrates that chronically optional overuse of healthy foods might bring to hazards to health. As the increasing trend of the size of purchasing healthy foods in Korea, pharmacoepidemiologic studies evaluating the safety and efficacy of the widely used healthy foods should be performed in the near future.

대학생 흡연량과 스트레스와의 관련성

배종면,안윤옥,박병주,Bae, Jong-Myon,Ahn, Yoon-Ok,Park, Byung-Joo 대한예방의학회 1994 예방의학회지 Vol.27 No.1

대학생 흡연은 주로 신입생때 이루어 지며, 일단 흡연이 습관화된 이후에는 자신에게 주어진 스트레스를 해소하는 방편으로 흡연을 이용하는 것으로 나타난다. 따라서 금연 뿐만 아니라 절대 흡연량을 줄이기 위해서는 개인의 스트레스를 조절 완화하는 여러 방법을 제시하고, 건전한 방향으로 스트레스 수준을 낮추도록 유도할 필요가 있다. 또한 대학신입생을 대상으로 흡연의 건강 유해영향을 교육 홍보를 하여, 흡연률을 낮추도록 노력해야겠다. The aim of this study was to assess the degree of association between individual stress and the amount of smoking among male senior students of a medical college. The questionnaire survey was conducted twice for collecting the data on stress level in terms of BEPSI score, smoking amounts, alcohol intake, and residence type in 1992 and 1993. Among the 223 responders, 39.9% were smokers. In the smokers, the association between stress level and smoking amount was significant after controlling for alcohol intake and residence type (p<0.1). Especially in the group of living without family, the association was more significant (p=0.06). Therefore, it is recommendable that the stress management program is called upon for the student smokers to reduce smoking amount.

제주도 재학생의 아토피 피부염 유병률 추정

배종면,신경수,Bae, Jong-Myon,Shin, Kyung-Sue 대한예방의학회 2009 예방의학회지 Vol.42 No.3

Objectives : The frequency of visiting clinics in Jejudo for treating atopic dermatitis (AD) has been reported to be higher than that for other counties of Korea. The aim of this work was to estimate the prevalence of AD for the students of the primary, middle and high schools in Jejudo, Korea. Methods : We planned to evaluate about 5,000 students, so classes were randomly selected by random systematic sampling methods. The parents of all the students in the selected classes were asked to respond to a structured questionnaire concerned with the prevalence of AD. Results : The prevalence of AD based on ever being diagnosed by a doctor, on currently being diagnosed by a doctor, on ever being treated for AD by a doctor, on currently being treated for AD by a doctor was 25.57% (95% CI=25.3-25.8), 14.67% (95% CI=14.5-14.9), 21.90% (95% CI=21.6-22.2) and 14.41% (95% CI=14.2-14.6), respectively. Conclusions : On comparing the prevalence of AD, the students in Jejudo had a higher number of recurrence events in spite of their lower number of cases. Further studies are needed to evaluate these aspects of AD.

상대생존율

배종면,Bae, Jong-Myon 대한예방의학회 2004 예방의학회지 Vol.37 No.3

제주도 암발생 양상에 관한 가설 제기 및 규명

배종면,Bae, Jong-Myon 대한예방의학회 2009 예방의학회지 Vol.42 No.1

Objectives : Using the population-based cancer registry in Jejudo, we found that Jejudo had lower incidence in stomach cancer than other regions in Korea. The aim of this study was to evaluate reasons for this difference. Methods : Citrus is the leading agricultural production in Jejudo, suggesting that lower cancer incidence in Jejudo could be explained by citrus fruit intake. We evaluated this hypothesis with quantitative systematic review(QSR). Results : Stomach cancer incidence was significantly lower, with a summary odds ratio(SOR) after QSR of 0.72 [95% CI=0.64-0.81]. In addition, the SOR of pancreatic cancer tended to be lower at 0.83 [95% CI=0.70-0.98]. The SOR of prostate cancer was slightly higher at 1.03 [0.89-1.19]. Conclusions : Quantitative systematic reviews for the effect of citrus fruit intake on cancer occurrence suggested that lower cancer incidence in Jejudo could be explained by intake of citrus fruits.

종설논문 : 임상진료지침 개발 및 확산에 있어 이해상충문제

배종면 ( Jong Myon Bae ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.2

Clinical practice guidelines are systematically developed statements to assist practitioners and patients in making appropriate health care decisions in specific clinical circumstances. The potential influence of industry in the development or dissemination of clinical practice guidelines raises ethical concerns. A review of the development and dissemination of the Surviving Sepsis Campaign guidelines shows that the interaction between the pharmaceutical industry and academic societies can undermine clinical guidelines and harm the industry`s reputation. Thus, it is argued here that the process of developing and disseminating clinical practice guidelines should not be tainted by problems of corporate support and transparency. Furthermore, the process should identify and manage any conflicts of interest and ensure the patient-centeredness of the evaluation of emerging medical evidence.

고 혈중 비타민 D에 의한 전립선암 발생 증가에 관한 가설

배종면 ( Jong-myon Bae ) 대한보건협회 2021 대한보건연구 Vol.47 No.3

연구목적 : 대장암과 유방암을 포함한 대부분의 원발암에 있어 혈중 비타민D 농도가 높을수록 보호효과가 있는 것으로 알려졌다. 그러나 전립선암의 경우 오히려 발생위험을 높인다는 체계적 고찰연구들이 보고되었다. 본 연구의 목적은 혈중 비타민D 농도와 전립선암 발생간의 관련성을 규명한 기존의 체계적 고찰연구들을 리뷰하는 것이다. 연구방법 : 혈중 비타민D 농도와 전립선암 발생간의 관련성을 규명한 기존의 체계적 고찰연구들을 분석 대상으로 삼았다. 그리고 새로운 가설제시를 위하여 갱신한 용량-반응 메타분석을 수행하였다. 주요결과 : 2014년 이전에 출판된 역학연구들을 선정한 체계적 고찰연구들은 혈중 비타민D 수준이 낮을수록 전립선암 발생위험이 높다고 발표하였다. 그러나 메타분석을 위하여 선정한 논문수가 19편을 넘어서면서 정 반대의 결론을 도출하였다. 17편의 코호트내 환자-대조군 연구와 5편의 추적 연구를 나누어 분석했을 때로 같은 결론을 얻어내었다. 용량-반응 메타분석은 코호트내 환자-대조군 연구에서 통계적 유의성을 보였다. 결론 : 비타민D 농도가 높을수록 전립선암의 발생 위험이 높다는 결론을 재확인하였다. 이에 역의 관계를 설명하기 위한 6가지 주요 가설들 -전립선암의 이질성, 건강검진에 따른 오류개입, 비선형 U 형 관련성, 전립선암 발생 단계에 따른 효과, 비타민D 수용체 유전자의 다형성- 을 정리, 제시하였다. Objectives : Consistent inverse relationships between circulating vitamin D level and risk of colorectal cancer and breast cancer were found. However, previous systematic reviews reported that higher circulating vitamin D level increases the prostate cancer risk. In this meta-epidemiological review, the author will summarize the results of previous systematic reviews evaluating the association between circulating 25-hydroxyvitamin D levels and prostate cancer risk. Methods : The subjects were previous systematic reviews for evaluating the association between serum vitamin D levels and prostate cancer risk. To suggest some new hypotheses, an updated dose-response meta-analysis for follow-up studies was conducted. Results : Previous systematic reviews showed that many epidemiological studies published before 2014 had investigated the hypothesis about the increased risk of prostate cancer associated with vitamin D deficiency/insufficiency. However, the opposite results of the previous hypothesis were derived as the number of papers selected for meta-analysis exceeded 19. Subgroup analysis by study design showed that significant results showed in 17 nested case-control studies and in five follow-up studies. Dose-response meta-analysis had a statistical significance in nested case-control studies, not in follow-up studies. Significance of Results : Six major hypotheses such as heterogeneity of prostate cancer, a healthy screened bias, a non-linear U-shaped relationship, a tumor-promoting effects of vitamin D, the engaging effect of vitamin D in initiation or progression stage, and some single-nucleotide polymorphisms of the vitamin D receptor gene, have been suggested about how vitamin D has an opposite direction of risk between the prostate and other cancers.

메타분석을 위한 생존곡선 활용법

배종면 ( Jong Myon Bae ) 한국보건정보통계학회 2015 보건정보통계학회지 Vol.40 No.2

On conducting a quantitative systematic reviews, some articles selected as the subject were presented solely in the form of Kaplan-Meier survival curves. To avoid publication bias, researchers should estimate the hazard ratio (HR) and its standard error (SE) representing the whole curve. This paper presents a practical method to estimate them.