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Comparison between Conservative Treatment of partial ACL Rupture and Reconstructive Surgery with BPTB Autograft in ACL Rupture (전방 십자 인대 파열후 자가 슬개건을 이용한 재건술군과 부분 손상후 보존적 치료군의 비교)

  • Lee Dong Chul;Lee Su Ho;Kim Dong Han
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.2
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    • pp.131-137
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    • 2002
  • Purpose: To evaluate and compare the functional results, activity status, and anterior stability between conservative group with partial ACL injury and reconstruction group with bone-patellar ten-don-bone autograft in ACL total rupture. Materials and Methods: Thirty-eight patients with ACL injury were diagnosed and treated with arthroscopy and followed for more than two years. The number of patients with partial injury was 12(mean age; 38.3) and reconstruction group was 26 (mean age; 25.3). Objective stability was estimated under anterior loading of 15 lb and 20 lb by KT-2000 Arthrometer (MED metric, USA). Functional evaluation using Lysholm score and Tegner activity score were performed. Results: Average functional score of Lysholm was 88.5 in partial injury group and 89.3 in reconstruction group. Average score of Tegner was 5.3 in partial injury group and 5.1 in reconstruction group(P<0.05).Average anterior displacement compared with normal side. Under loading of 20lb, 1.7$\pm$4.3 mm in partial injury group, 2.3$\pm$1.9 mm in reconstruction group were anterior displaced (P<0.05). Under loading of 15lb, 1.2$\pm$1.0 mm in partial injury group, 1.4$\pm$1.5 mm in reconstruction group were dis-placed (P<0.05). There were giving way, effusion, instability and anterior knee pain in complication. Giving way was the frequent complication in the partial injury group. Conclusions: Clinical results of both group were similar. Functional evaluation of Lysholm was good and status of Tegner activity was maintained to physical fitness activites (jogging, regular bik-ing) in both groups on average. The results of conservative treatment for the partial ACL injury (less than 50$\%$) was satisfactory and equivalent to that of reconstructive treatment for the total ACL injury.

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Nutrition Intake according to Food and Exercise Habits in Female College Students of Yang-Ju si (경기도 양주시 여대생의 식습관, 운동습관, 건강관련행동이 영양섭취수준에 미치는 영향)

  • Rha, Young Ah;Kang, Min Jeong;Lee, Sun Ho;Kim, Jung Yun
    • Culinary science and hospitality research
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    • v.21 no.4
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    • pp.284-293
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    • 2015
  • This study was intended to investigate food, exercise habits, perception of health status and the effects of nutrient intake of female college students. Food habits such as regularity of meal time, repast of breakfast, numbers of night snack per week and duration of meal were assessed via a self reporting questionnaire, and 24hrs recall method for nutrient intake was obtained from 155 female college students in Yangju-si. The mean height and weight of the subjects were $161.25{\pm}3.52cm$ and $52.26{\pm}4.52kg$, respectively. The average intakes of energy and nutrients were below the Korea recommended dietary allowance(RDA). Especially, The nutrient intakes(energy, protein, fat, fiber, calcium, iron, phosphorus, zinc, sodium, potassium, vitamin B6, niacin, vitamin C, folate, vitamin E, cholesterol) of the group in which the regularity of meal time per week was 5~7 days was significantly higher than the group in which the regularity of meal time was < 3 days (p<0.005). The nutrient intakes influenced by the food habit such as the regularity of meal time, skipping breakfast, and the numbers of night snack per week but did not differ in accordance with the regular exercise habits and perception of health status. These findings suggest that nutritional education based on female college students' food habits(regularity of meal time, skipping breakfast and night snacks per week, and duration of meal) may be required to improve dietary variety. It is considered that the improvement in dietary habits will contribute to the improvement of nutrition.

Timing and Risk Factors of Adoption for Legally-Free Foster Children after Having Parental Rights Terminated in the U. S. (미국 위탁아동의 친권상실선고 이후 입양 결정요인에 관한 생존분석)

  • Song, Min-Kyoung
    • Korean Journal of Social Welfare
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    • v.59 no.1
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    • pp.301-327
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    • 2007
  • The purpose of this study is to examine the timing and the risk factors associated with the adoption of legally-free foster children. The sample of the study was drawn from foster care files of Adoption and Foster Care Analysis and Reporting System(AFCARS) in 32 states between October 1998 (FY 1999) and September 2002(FY 2002). The timing post-TPR to adoption was examined by plotting the Kaplan-Meier cumulative hazard function for adoption and by plotting the KM hazard functions stratified by child's race and child's age at TPR. Cox proportional-hazards regression analysis was used to identify risk factors for adoption of legally-free foster children after TPR. The hazard of adoption was very low immediately after TPR but increased steadily starting at 3 months and then declined after 20 months. The cumulative hazard functions for White non-Hispanic children and Black non-Hispanic children crossed over at 13 months after TPR. Racial minority status, older age, and disability were negatively associated with the hazard of adoption. Physical abuse, sexual abuse had the lower hazard for adoption compared by neglect. Caretaker's inability to cope had the slightly lower hazard for adoption whereas inadequate housing showed the slightly greater hazard for adoption. Characteristics of foster care services turned into be powerful predictors of adoption. Specifically, legally-free children placed in pre-adoptive homes, those who shared the same racial/ethnic background with their foster caretakers, and those who were placed in two-parent families have a greater likelihood of adoption. The findings highlight the importance of foster care service provisions after TPR to facilitate adoption of legally-free foster children. Furthermore, a more substantial resources and targeted support for foster children who experience physical abuse and sexual abuse in need of adoption should be provided for moving the foster children into permanency.

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The Implementation and limits of Involuntary Detention of the Tuberculosis Prevention Act (결핵예방법의 격리명령의 실행과 한계에 관하여)

  • Kim, Jang Han
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.55-84
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    • 2015
  • The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.

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A Study of Portrait of Yang Zhuxi housed in the Palace Museum in Beijing (원대(元代)의 왕역(王繹)·예찬(倪瓚) 합작 <양죽서소상(楊竹西小像)> 연구)

  • Chang, June-gu
    • Korean Journal of Heritage: History & Science
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    • v.47 no.2
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    • pp.114-131
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    • 2014
  • The Portrait of Yang Zhuxi(楊竹西小像) at the Palace Museum in Beijing holds important significance as one of the rare portraits from Yuan Period and as a painting with a definite year of creation in 1363. It is also noteworthy in that it is the only remaining work of Wang Yi(王繹), who was one of the critical portrait painters during the second half of Yuan Period and the author of Xiexiang Mijue(寫像秘訣), the first book on the portrait theories, that it was created in conjunction with Ni Zan(倪瓚), one of the utmost landscape painters of the times, and that it was an early case of landscape and figure painting-format portraits. The figure in Portrait of Yang Zhuxi was originally known as Yang Wu(楊瑀), a high official during Yuan Period, but it was a misunderstanding on the part of Li Rihua(李日華), a literary figure from Ming Dynasty. The actual model was Yang Qian(楊謙), a reclusive literary figure in the Songjiang(松江) region. Yang Qian is estimated as one of the central figures with a high reputation in the literary community of Jiangnan those days. Portrait of Yang Zhuxi was depicted by borrowing the icon of such hermits as Su Shih(蘇軾), which seems like a proper choice to express Yang Zhuxi, a reclusive literary figure. Furthermore, the rocks and pine trees described by Ni Zan reinforced the significance of the portrait through their traditional symbolism of man of virtue and man of letters, respectively. Portrait of Yang Zhuxi used the Baimiao Manner(白描法), thus being differentiated from other portraits from the same period. Even though there is no coloring in the painting, it boasts more excellent realism than colored portraits. It expressed the body with the graceful and controlled Li Gonglin(李公麟) and Zhao Mengfu(趙孟?) style Baimiao Manner, raising its dignity further. In terms of functions, Portrait of Yang Zhuxi is strongly characterized by the appreciative function unlike other portraits focused on the ceremonial function. Being created to be viewed and appreciated by the model himself and his friends, the portrait was very significant to promote their friendship. However, there was a great intention to reflect the emotions of the model himself and his friends in the painting beyond the simple appreciation level.

Investigation on the Awareness and Preference for Wood Culture to Promote the Value of Wood: I. Awareness of Wood and Cultural Experience (목재의 가치증진을 위한 목재문화에 대한 인식 및 선호도 조사: I. 목재와 문화체험에 대한 인식)

  • HAN, Yeonjung;LEE, Sang-Min
    • Journal of the Korean Wood Science and Technology
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    • v.49 no.6
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    • pp.616-642
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    • 2021
  • Improving public awareness of wood is essential for achieving the goal of establishing wood culture by expanding the use of wood. This study presents a basic examination of the strategy of revitalizing wood culture and a survey of its current status and requirements. The survey was divided into seven categories: awareness of wood culture; use characteristics of wood culture; preference and demand for wood culture; awareness of sub-fields of wood culture; awareness of the cultural resources of wood; trends of wood utilization; and wood-related living environment. Based on the survey results, the study analyzed four items: awareness of wood and cultural experience; awareness of the cultural resources of wood; wood-related living environment and trends of wood utilization; and preference and demand for wood culture. In this study, the public awareness of wood and cultural experiences, the first of four items, was analyzed using the survey results. Generally, wood and wood culture are viewed as materials and a cultural heritage, respectively. Moreover, wood is ecofriendly. However, no substantial difference was observed between the two perceptions. Forty-five percent of the respondents reported that using wood exerts a positive effect on the body and mind. However, such use also destroys forests. Additionally, the recognition of wood-related workers, such as engineers or skilled workers, was relatively low compared with educators, such as wood education experts. Moreover, less than 50% of the respondents answered that major projects related to wood culture are well-known, whereas 30% participated in wood education, such as woodworking experience, where the majority required hand tools. Furniture, wooden accessories, and wooden buildings were among the objects that individuals intended to make through the wood culture program. Approximately 23% of the respondents were aware about the wood culture experience center, while approximately 50% had visited it. The response rate to woodworking technology was 73%, where the highest response was found for wood education experts. To improve public awareness about wood, the importance of entertainment factors over educational factors should be considered in the experience of individuals. To provide opportunities to experience wood culture for more individuals, developing and actively promoting various contents, including entertainment elements, are necessary.

Exploring the Trend of Korean Creative Dance by Analyzing Research Topics : Application of Text Mining (연구주제 분석을 통한 한국창작무용 경향 탐색 : 텍스트 마이닝의 적용)

  • Yoo, Ji-Young;Kim, Woo-Kyung
    • Journal of Korea Entertainment Industry Association
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    • v.14 no.6
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    • pp.53-60
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    • 2020
  • The study is based on the assumption that the trend of phenomena and trends in research are contextually consistent. Therefore the purpose of this study is to explore the trend of dance through the subject analysis of the Korean creative dance study by utilizing text mining. Thus, 1,291 words were analyzed in the 616 journal title, which were established on the paper search website. The collection, refining and analysis of the data were all R 3.6.0 SW. According to the study, keywords representing the times were frequently used before the 2000s, but Korean creative dance research types were also found in terms of education and physical training. Second, the frequency of keywords related to the dance troupe's performance was high after the 2000s, but it was confirmed that Choi Seung-hee was still in an important position in the study of Korean creative dance. Third, an analysis of the overall research subjects of the Korean creative dance study showed that the research on 'Art of Choi Seung-hee in the modern era' was the highest proportion. Fourth, the Hot Topics, which are rising as of 2000, appeared as 'the performance activities of the National Dance Company' and 'the choreography expression and utilization of traditional dance'. However, since the recent trend of the National Dance Company's performance is advocating 'modernization based on tradition', it has been confirmed that the trend of Korean creative dance since the 2000s has been focused on the use of traditional dance motifs. Fifth, the Cold Topic, which has been falling as of 2000, has been shown to be a study of 'dancing expressions by age'. It was judged that interest in research also decreased due to the tendency to mix various dance styles after the establishment of the genre of Korean creative dance.

Bone Density and Related Factors of Vegetarian and Non-vegetarian University Students in Seoul Area (서울지역 채식.비채식 대학생의 골밀도에 미치는 영향요인에 관한 연구)

  • Chung, Nam-Yong;Choi, Soon-Nam
    • Journal of the Korean Society of Food Culture
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    • v.21 no.1
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    • pp.86-98
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    • 2006
  • This study was conducted to investigate factors affecting bone density of food and nutrition vegetarian and non-vegetarian university students in Seoul area. Data for food habits, dietary and health-related behaviors were obtained by self administered questionnaires. BQI(bone quality index) of the subjects was measured by an Quantitative Ultrasound (QUS). The results are summarized as follows: The average height, weight, BMI and osteopenia percentage of the vegetarian and non-vegetarian male and female student were 172.61cm, 62.42kg, 20.98 and 24.2%; 175.38cm, 72.52kg, 23.71 and 16.7%; 160.47cm, 55.76kg, 21.66 and 55.9%; 161.77cm, 56.34kg, 21.53 and 37.6%, respectively. The BQI of the subjects were 101.73 and 107.43 in male student group, and 84.15, 89.64 in female student group, respectively. The BQI, Z-score value of bone density was significantly different in female group. Weight and BMI were positively related with BQI in male and female group. BQI was positively affected by nutrition supplement and negatively affected by seafood in vegetarian male student group. In vegetarian female student group, amount of meal was positively related with BQI and meal regularity was negatively related BQI. The result of this study revealed that the desirable food habits, dietary behaviors and health-related lifestyles may have a beneficial effect on bone density. They should have practically and systematically organized nutritional education on optimum body weight, good eating habits, weight bearing exercise and intakes of good quality nutrient for higher bone density level.

Philosophical Stances for Future Nursing Education (미래를 향한 간호교육이념)

  • Hong Yeo Shin
    • The Korean Nurse
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    • v.20 no.4 s.112
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    • pp.27-38
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    • 1981
  • 오늘 저희에게 주어진 주제, 내일에 타당한 간호사업 및 간호교육의 향방을 어떻게 정하여야 하는가의 논의는 오늘날 간호계 주변에 일어나고 있는 변화의 실상을 이해하는 데서 비롯되어져야 한다고 생각하는 입장에서 먼저 세계적으로 건강관리사업이 당면한 딜레마가 어떠한 것이며 이러한 문제해결을 위해 어떠한 새로운 제안들이 나오고 있는가를 개관 하므로서 그 교육적 의미를 정의해 보고 장래 간호교육이 지향해야할 바를 생각해 보려 합니다. 오늘의 사회의 하나의 특징은 세계 모든 나라들이 각기 어떻게 전체 국민에게 고루 미칠 수 있는 건강관리체계를 이룩할 수 있느냐에 관심을 모으고 있는 사실이라고 봅니다. 부강한 나라에 있어서나 가장 빈궁한 나라에 있어서나 그 관심은 마찬가지로 나타나고 있읍니다. 보건진료 문제의 제기는 발달된 현대의학의 지식과 기술이 지닌 건강관리의 방대한 가능성과 건강 관리의 요구를 지닌 사람들에게 미치는 실질적인 혜택간에 점점 더 크게 벌어지는 격차에서 발생한다고 봅니다. David Rogers는 1960년대 초반까지 갖고 있던 의료지식의 축적과 민간인의 구매력 향상이 자동적으로 국민 건강의 향상을 초래할 것이라고 믿었던 순진한 꿈은 이루어지지 않았고 오히려 의료사업의 위기는 의료지식과 의료봉사간에 벌어지는 격차와 의료에 대한 막대한 투자와 그에서 얻는 건강의 혜택간의 격차에서 온다고 말하고 있읍니다. 균등 분배의 견지에서 보면 의료지식과 기술의 향상은 그 단위 투자에 대한 생산성을 낮춤으로서 오히려 장애적 요인으로 작용해온 것도 사실이고 의료의 발달에 따른 일반인의 기대 상승과 더불어 의료를 태성의 권리로 규명하는 의료보호사업의 확대로 야기되는 의료수요의 급증은 모두 기존 시설 자원에 압박을 초래하여 전래적 의료공급체제에 도전을 가해 왔으며 의료의 발달에 건 기대와는 달리 인류의 건강 문제 해결은 더욱 요원한 과제로 남게 되었읍니다. 현시점에서 세계인구의 건강문제는 기아, 영양실조, 안전한 식수 공급 및 위생적 생활환경조성의 문제에서부터 가장 정밀한 의료기술발달에 수반되는 의료사회문제에 이르는 다양한 문제를 지니고 있으며 주로 각개 국가의 경제 사회적 여건이 이 문제의 성격을 결정짓고 있다고 볼수 있읍니다. 그러나 건강 관리에 대한 요구는 영구히, 완전히 충족될 수 없는 요구에 속한다는 의미에서 경제 사회적 발달 수준에 상관없이 모든 국가가 공히 요구에 미치지 못하는 제한된 자원문제로 고심하고 있는 실정입니다. 또 하나의 공통된 관점은 각기 문제의 상황은 달라도 오늘날의 건강 문제는 주로 의료권 밖의 유전적 소인, 사회경제적, 정치문화적인 환경여건과 각기 선택하는 삶의 스타일에 깊이 관련되어 있다는 사실입니다. 따라서 오늘과 내일의 건강관리 문제는 의학적 견지에서 뿐 아니라 널리 경제, 사회, 정치, 문화적 관점에서 포괄적인 접근이 시도되어야 한다는 점과 의료의 고급화, 전문화, 일변도의 과정에서 소외되었던 기본건강관리체계 강화에 역점을 둔 다양하고 탄력성 있는 사업전개가 요구되고 있다는 점입니다. 다양한 건강관리요구에 적절히 대처할 수 있기 위한 그간 세계 각처에서 시도된 새로운 건강관리 접근과 그 제안을 살펴보면 대체로 4가지의 뚜렷한 성격들로 집약할 수 있을 것 같습니다. 그 첫째는 건강관리사업계획 및 그 수행에 있어 지역 사회의 적극적 참여를 유도하는 일, 둘째는 지역단위의 일차보건의료에서 부터 도심지 신예 종합병원, 시설 의료에 이르기까지 건강관리사업을 합리적으로 체계화하는 일. 셋째로 의료인력이용의 효율화 및 비의료인의 훈련과 협조 유발을 포함하는 효과적인 인력관리에 대한 제안과 넷째로 의료보험 및 각양 집단 의료유형을 포함하는 대체 의료재정 운영관리에 관련된 제안들을 들 수 있읍니다. 건강관리사업에 있어 지역사회 참여의 의의는 첫째로 사회 경제적인 제약이 모든 사람에게 가능한 최대한의 의료를 모두 고루 공급하기 어렵게 하고 있다는 점에서 제한된 정부재정과 지역사회가용자원을 보다 효율적으로 이용할 수 있게 하는 자조적이고 자율적인 지역사회건강관리체제의 구현에 있다고 볼 수 있으며 둘때로는 개인과 가족 및 지역민의 건강에 영향하는 많은 요인들은 실질적으로 의료권 외적 요인들로서 위생적인 생활양식, 식사습관, 의료시설이용 등 깊이 지역사회특성과 관련되어 국민보건의 실질적 향상을 위하여는 지역 주민의 자발적인 참여가 필수여건이 된다는 점 입니다. 지역 단위별 체계적인 의료사업의 전개는 제한된 의료자원의 보다 합리적이고 효율적인 이용을 가능하게 하며 요구가 있을때 언제나 가까운 거리에서 경제 사회적 제약을 받지 않고 이용할 수 있는 일차건강관리망을 통하여 건강에 관련된 정보를 얻으며 질병예방, 건강증진 및 기초적인 진료의 도움을 얻을 수 있고 의뢰에 대한 제2차, 제3차 진료에의 길은 건강관리사업의 질과 폭을 동시에 높고 넓게 해 줄 수 있는 길이 된다는 것입니다. 인력 관리에 관련된 두가지 기본 방향으로서는 첫째로 기존보건의료인력의 적정배치 유도이고 둘째는 기존인력의 역할확대, 조정 및 비의료인의 교육훈련과 부분적 업무대체를 들수 있으며 이러한 인력관리의 기본 방향은 부족되는 의료인력의 생산성을 높이고 주민들의 자조적 능력을 강화시킨다는 데에 두고 있음니다. 대체적 의료재정운영안은 대체로 의료공급과 재정관리를 이원화하여 주민의 경제능력이 의료수혜의 장애요소로 작용함을 막고 의료인의 경제적 동기에 의한 과잉치료처치에 의한 낭비를 줄임으로써 의료재정의 투자의 효과를 증대하는 데(cost-effectiveness) 그 기본방향을 두고 있다고 봅니다. 이러한 주변의료 사회적인 동향이 간호교육의 미래상에 끼치는 영향은 지대한 것이라 봅니다. 첫째로 장래 세계인구의 건강문제는 정치, 사회, 경제, 환경적인 의료권 밖의 요인들에 의해 더욱 크게 영향 받는다고 전제한다면 건강문제해결에 있어서도 전통적인 의료사업의 접근에서 더나아가 문제발생의 근원이 되는 생활개선이라는 차원에서 포괄적 접근을 생각하여야 하고 이를 위해선 정치, 경제, 사회전반에 걸친 깊이있는 이해과 주민의 생활환경에 직접 영향하는 교통수단, 통신망 mass media, 전력문제, 농업경영방법 및 조직적 사회활동 등 폭넓은 이해가 요구된다고 봅니다. 둘째로, 지역사회참여의 의의를 인정한다면 지역민의 자발적 참여를 효과적으로 유발시킬수 있고 의료집단과 각종 주민조직과 일반주민들 사이에서 협조적으로 일할수 있는 역량을 기르기위한 교육적 준비가 요구된다고 봅니다. 셋째로, 지역주민의 건강관리 자조능력 강화를 하나의 목표로 삼는다면 치료자에서 교육자로, 지도자에서 촉진자로, 제공자에서 지원자료의 역할의 변화 내지 다양화를 요구하게 될 것이므로 그에 대처할 수 있는 준비가 필요하다고 봅니다. 넷째로, 생각되어야 할 점은 지역중심건강관리사업을 지향하는 보건의료의 이념적 방향과 그에 상응하는 구체적 접근방법을 효율적으로 적용하기 위해서는 종횡으로 연결되는 의사소통체계의 정립과 민활한 정보교환이 이루어질 수 있어야 한다는 점에서 의사소통의 구심체로서 역할할 수 있는 역량을 함양해야 할 교육적 과제가 있다고 봅니다. 마지막으로 생각되어야 할 점은 지역중심으로 전개될 건강관리사업은 건강증진 및 질병예방적 측면과 질병진료 및 회복과 재활에 이르는 종합적이고 포괄적인 사업이어야 한다는 점에서 종래 공공 의료부문과 사설의료기관 사이에 나누어져 있던 예방의학과 치료의학의 통합 뿐 아니라 정부주축으로 이루어 지고 있는 지역사회개발사업 및 농촌지도사업과 종교 및 각종 민간인 집단이 벌이고있는 사업들과의 전체적인 통합적 접근이 이루어져야 한다고 생각하는 입장에서 종래 간호교육이 강조하지 않던 진료의 의무와 대외적 조직활동에 대한 보완적인 교육조치가 요구된다고 봅니다. 간호의 학문체계로서의 입장은 오랜 역사를 두고 논의의 대상이 되어왔으나 아직까지 뚜렷이 어떤 것이 간호 특유의 지식체계이며 건강문제에 관련하여 무엇이 간호특유의 결정영역이며 이 결정과 그 결과를 어떠한 방법으로 치료적 행위로 옮길 수 있는가에 대한 확실한 답을 얻지 못하고 있는 실정이라고 봅니다. 다만 근래에 제시된 여러 간호이론들 속에서 공통적으로 이야기되어지고 있는 개념들로선 우선 간호학문을 건강과 질병에 관련된 인간의 전인적이고 전체적인 상황을 다루는 학제적 과학으로서보는 입장이 있고 따라서 생물신체적인 면 외에 정신심리적, 사회경제적, 정치문화적 환경과의 상호작용 속에서 인간의 건강과 질병문제를 생각한다는 지향을 갖고 있다고 말할 수 있겠읍니다. 간호교육은 간호계 내적인 학문적, 이론적 체계화의 요구에 못지않게 대민봉사하는 전문직으로서의 사회적 책임을 감당해야하는 중요과제를 안고있어 변화하는 사회요구에 효과적으로 대처해 나가야 할 당면문제를 안고 있읍니다. 간효역할 확대, 보건진료원훈련 등 이러한 사회적 요구에 대응하려는 조치가 되겠읍니다. 이러한 시점에서 간호계가 분명히 짚고 넘어가야 할 사실은 이러한 움직임들이 종래의 의사들의 외업무공급을 연장 확대하는 입장에 서서 간호의 특수전문직 명목을 흐리게 할수있는 위험을 감수할 것인지 아니면 가능한 대체방안을 갖고 간호전문직의 독자적인 진로를 개척하면서 다각적인 도전을 받아들일 준비를 갖추든지 그 방향을 뚜렷이 해야할 일이라 생각합니다. 저로서는 이미 잘 훈련된 간호원들과 조산원들의 교육적, 경험적 배경을 기반으로 지역사회 최일선 건강관리요원으로 사회적 효능을 다 할수 있는 일차건강관리간호조직의 구현을 대체방안으로 제시하고 싶습니다. 간호원과 조산원들의 훈련된 역량과 건강관리체제의 구조적 변화를 효과적으로 조화시킨다면 대부분의 세계인구의 건강문제는 해결가능하다고 보는 입장입니다. 물론 정책과 의료와 행정적지원이 활성화되어지는 환경속에서만 그 기대하는 결과가 확대되리라는 점 부언하는 바입니다. 마지막으로 언급하고 싶은 점은 바로 오늘의 주제 ''교육의 동역자-선생과 학생''이라는 개념입니다. 특히 상회정의적 입장에서 보는 의료사업전개에 지역민 내지 의료소비자의 참여를 강조하는 현시점에 있어 교육자와 학생이 교육의 현장에서 서로 동역자로서 학습의 책임을 나누는 경험은 아주 시기적으로 적합하여 교육적으로 지대한 의미를 갖는 것이라고 생각합니다. 이에 수반되어져야 할 역할의 변화에 수용적인 자세를 갖고 적극 실제적용하려 노력하는 선생앞에서 자주적 결정을 행사해본 학생이야말로 건강관리대상자로 하여금 같은 결정권을 행사할수 있도록 촉구하여 주민의 자조적 역량을 기르고 의료사업의 민주화, 인간화를 이룩할 수 있는 길잡이가 될 수 있으리라 믿는 바입니다.

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Analysis of Frequent Disease and Medical Expenses Structure of Patients Admitted in a Vaterans Hospital (일개 보훈병원 입원환자의 상병 및 진료비 구조분석)

  • Kim, Kyoung-Hwan;Lee, Sok-Goo;Kim, Jeong-Yeon
    • Journal of agricultural medicine and community health
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    • v.30 no.1
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    • pp.1-14
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    • 2005
  • Objectives: This study attempts to analyze the length of hospital stay and expenses of frequent disease admitted in a Vaterans Hospital. Methods: Data was collected from January 1, 2001 to December 31, 2003 from the Claim records of 9,640 patients in a Vaterans Hospital. Results: The results were as follows: 1. In age & sex distribution, there was male 70.9%, female 29.1%, and 35.8% of them is 70 age group. Frequency by insurance program was Health insurance 78.1%, Medical aid 14.2%, no insurance 4.1%, others 3.6%. Distribution of each department was internal medicine 28.3%, orthopedic surgery 21.3%, surgery 16.6%, neurosurgey 7.1%, pediatrics 5.9%. Also, in the veterans group, male to female patient ratio was 99.3% male to 0.7% female, them over 70 years old was 51.6%, and them which live in daejeon was 43.5%. 2. In frequency of disease, there was gastroenteritis 4.8%, pneumonia 3.8%, cartaract 3.7%, cerebral infarct 3.2%, hyperplasia of prostate 3.0%. In frequency of korean standard classification of diseases, there was injury and poisoning and certain other consequences of external causes 17.1%, diseases of digestive system 16.1%, diseases of musculoskeletal system and connective tissue 13.9%, diseases of respiratory system 9.4%, diseases of genitourinary system 8.6%. Also, in veterans group, frequency of them was diseases of musculoskeletal system and connective tissue 19.4%, diseases of digestive system 16.8%, injury and poisoning and certain other consequences of external causes 15.7%, diseases of genitourinary system 9.7%, diseases of circuatory system 8.2%. 3. Average length of hospital stay was 29.0 days for total patients, 51.8 days for the veterans group, 15.7 days for the non-veterans one. Average total expenses was 3,669,579 won, the veterans group 7,263,877 won, the non-veterans one 1,560,333 won. The ratio of insurer to insuree was 55.2 : 44.8, the ratio of amount paid by patient in the veterans group 61.7%, in the non-veterans one 33.0%. 4. In items of medical expenses, fee for hospital accommodation was 34.7%, fee for medication 13.2%(injection 7.8%, drug 5.4%), fee for service 48.6%(physical therapy 26.3%, operation 9.7%, laboratory examination 5.2%, radiological examination 3.1%, etc), others 3.4%. In them for the veterans group, fee for physical therapy was 35.3%, fee for hospital accommodation 35.2%, fee for injection 6.2%, fee for operation 5.9%, for the non-veterans one, fee for hospital accommodation 35.7%, fee for operation 16.4%, fee for injection 11.4%, fee for laboratory examination 8.3%. 5. In the comparison of the frequency by Korean standard classification of diseases and distance between the hospital and home, the region under 21.5Km was more frequent in symptoms, signs an abnormal clinical and laboratory findings 56.0%, injury and poisoning and certain other consequences of external causes 55.6%, diseases of the eye and adnexa 52.9%, the one over 21.5Km was more frequent in neoplasms 57.4%, diseases of musculoskeletal system and connective tissue 55.9%, diseases of genitourinary system 53.5%.

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