• 대한영양사협회학술지
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• 제14권1호
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• pp.23-35
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• 2008

Improved nutritional intake contributes to maintaining health and quality of life in elderly population and also reducing individual and social medical costs. Most of nutrition assistance programs for elderly, such as congregate or home-delivered meal programs, are not currently serviced in rural communities mainly due to low cost efficiency of program operation. However, the needs and necessity of such programs are presumed to be higher in rural area where the population density of elderly at nutritional risk is relatively high. Therefore, the purpose of this study was to develop a community-based meal program for the rural elderly. In 2007, four rural communities located in Jeon-Nam province were selected and the pilot meal program was applied for three months. Following are key features of the meal program model developed in this study: 1) meal production and service are operated by elderly participants to overcome the voluntary personnel shortage 2) utilization of locally-produced foods is maximized to reduce the meal cost, 3) traditional cooking methods are applied to adjust the food preference of elderly, and 4) foods are serviced on site to minimize the food safety problem possibly caused by delivery process. The pilot programs resulted in high satisfaction with the programs of participating elderly. The community-based meal program model developed in this study is expected to be used as an effective nutrition and health intervention model for the rural elderly.

• 농촌의학ㆍ지역보건
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• 제36권4호
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• pp.238-250
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• 2011

지속적인 암환자 및 암 관련 의료비용 급증은 환자 개인의 고통 및 경제적 부담으로 작용할 뿐만아니라 사회적인 부담이 되고 있다. 이에 재가암 환자에 대한 통증관리 등의 서비스 제공은 의료 비용을 절감하는데 효과가 있을 것으로 여겨지고 있다. 따라서 재가암환자에 대한 적절한 의료 및 복지 서비스 등을 제공하기 위한 자료로 활용하고자 재가암환자관리사업 수혜자의 서비스 요구도에 대하여 각 보건소의 재가암환자관리사업 담당자가 재가암환자관리사업 수혜자 방문시 면접조사방법으로 조사하였고, 불충분응답자 15명을 제외한 661명을 최종 분석대상으로 하였다. 재가암환자의 서비스 요구도에 대한 요인분석 결과 5가지 영역으로 분류할 수 있었고, 요인별 신뢰도는 0.593~0.890이었다. 요구도의 순위는 사회적 지지, 정보 및 교육제공, 심리적 문제해결, 신체증상해결, 가사도움 순으로 조사되었다. 대상자를 암 치료 및 진행 정도에 따라 말기암 환자, 치료중인 암환자, 암 완치자로 분류하였을 때, 말기암환자의 요구도가 가장 높게 나타났으며, 사회적지지, 심리적 문제 해결, 정보 및 교육 순서로 요구도가 높았다. 나머지 그룹에서는 사회적지지, 정보 및 교육, 심리적 문제 해결 순으로 말기 암환자와 차이를 보였다. 뿐만 아니라, 연령별, 거주 지역별, 종교 유무에 따른 서비스 요구도에 차이가 관찰되었고, 이를 바탕으로 현재 제공되고 있는 재가암환자관리의 효율적인 추진을 위해 대상자 분류, 연령별 및 거주 지역별 특성에 따른 서비스가 제공될 수 있도록 해야 할 것이다.

• 한국임상약학회지
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• 제25권4호
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• pp.273-279
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• 2015

Objective: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. Method: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were subclassified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. Results: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). Conclusion: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.

• 한국콘텐츠학회논문지
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• 제14권5호
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• pp.107-116
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• 2014

본 연구는 지역사회네트워크 기반 사회복지프로그램 기획을 준비함에 있어 컨셉트 맵핑을 활용하고 그 적용가능성을 경험적으로 확인하는 것이다. 컨셉트 맵핑은 다양한 이해관계자들 사이의 모호하고 복잡한 아이디어를 구조화하여 시각적으로 제시해 주는 의사결정 도구이다. 이미 상담, 간호, 공중보건 등 휴먼서비스 영역을 중심으로 프로그램 기획 및 평가 과정에서 나타나는 복잡하고 추상적인 아이디어를 개념화하는데 활용되고 있다. 최근, 우리나라에서도 상담 및 의료 영역에서 서비스 제공자와 이용자 간의 존재하는 성과의 차이를 경험적으로 인지하고, 합의를 이끌어 내는 도구로 활용하고 그 효과성이 발표되고 있다. 본 연구에서는 부산광역시 북구에서 아동 청소년을 대상으로 진행되고 있는 부산공동모금회지원 CI사업의 3차년도 사업기획을 준비하면서 사업주체들이 기대하는 성과를 컨셉트 맵핑을 활용하여 개념화하였다. 컨셉트 맵핑은 준비 단계, 아이디어 수집 단계, 서술문 구조화 단계, 표현 단계, 분석결과 해석 단계, 유용화 단계로 이루어졌다. 참여자들은 부산 북구 사회복지기관 종사자 11명이였으며, 이들이 제시한 서술문은 총 60개였다. 이들이 제시한 서술문을 유사성 행렬 형태로 전환하여 다차원 척도법 분석을 실시하였다. 군집은 총 5개로, '아동 청소년의 인식 및 태도변화', '아동 청소년 체계의 변화', '우호적인 지역사회 형성', '지역주민의 변화', '사업공급주체의 변화'였다. 이 중 가장 우선적으로 성취되어야 할 성과는 '아동 청소년의 인식 및 태도 변화'로, 이 성과를 중심으로 3차년도 사업을 기획하게 되었다. 컨셉트 맵핑을 활용하여 성과를 개념화하는 의사결정과정을 거치면서, 참여 구성원들은 사업의 성과에 대해 명확하게 개념화하였고, 이 성과에 대한 합의가 도출되었다.

• 이베로아메리카
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• 제21권2호
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• pp.1-23
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• 2019

본 연구는 지역주민참여 보건 프로그램이 정치, 경제적 요인에 의해 실천되는 과정을 파라과이 뎅기열 예방 프로그램인 밍가 암비엔탈을 통해 분석한 것이다. 비판적 의료인류학 분야에서는 보건 의료 프로그램의 실천이 해당 질병의 예방과 퇴치라는 본연의 목적 이외에 사회문화 및 정치경제적 요인이 주요 변수로 작용될 수 있음을 설명하고 있다. 같은 맥락에서 본 연구도 지역 공동체 기반의 보건프로그램이 다양한 외적 요인에 의해 어떻게 작동되는가를 분석하였다. 그 결과 밍가 암비엔탈 프로그램은 뎅기열 퇴치라는 보건 프로그램으로서 실효성에 대한 우려에도 불구하고 국가와 지역사회의 정치인, 기업 등 다양한 이해관계 집단에 의해 실천되는 경향을 보이고 있다. 이 사례를 통해 본 연구는 지역주민참여 보건 프로그램이 그 본래의 목적과 다르게 정치경제적 관계에 의해 작동될 수 있음을 파악하였다.

• 대한지역사회작업치료학회지
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• 제4권2호
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• pp.75-83
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• 2014

목적 : 본 연구는 강원도 태백지역에 거주하는 초기치매환자를 대상으로 실시한 방문 인지 작업치료 프로그램의 효과를 알아보고자 하였다. 연구방법 : 초기치매환자 30명을 대상으로 작업치료학과 학생 30명과 자원봉사자들이 주 1회 총 8회기의 가정방문 인지작업치료 중재를 실시하였다. 프로그램 전후의 대상자들의 인기기능의 변화를 알아보기 위해 MMSE-K를 사용하여 측정하였다. 또한 가정방문 인지작업치료에 대한 초기치매 환자들의 인식과 만족도를 확인하였다. 결과 : 초기 치매환자에게 가정방문 인지작업치료 적용한 결과 전반적인 인지기능의 향상이 나타났으며 특히 지남력, 기억회상, 주의집중력, 언어력의 경우 통계학적으로 유의한 향상이 나타났다. 결론 : 인지기능의 향상과 일상생활능력의 향상을 위한 가정방문 작업치료 프로그램이 치매환자의 중재에 있어 유용하게 적용될 것으로 사료되며 향후 가정방문 작업치료 서비스 도입을 위한 다양한 가정방문 작업치료 중재 프로그램 개발이 필요하다.

• 가정간호학회지
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• 제6권
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• pp.5-18
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• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• 웰빙융합연구
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• 제2권1호
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• pp.1-8
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• 2019

"In the future, 80% of doctors will be replaced by advanced technology." It has been talked about for a long time. When I first heard this story, people said it was ridiculous. But now that AlphaGo has won the Go match against Lee Se-dol, and many global companies have come up with a variety of services and products based on artificial intelligence, the story has become no more than ridiculous. In other words, it is beginning to come true. Artificial intelligence technology is already widely used in manufacturing and service industries. This spread of artificial intelligence is sure to usher in an era of great change in our future. And it is safe to say that it is the "medical world" where the biggest changes will be made. So how on earth does artificial intelligence replace medical personnel? If replaced, where would you stand out? In order to understand this, we must first be familiar with deep learning, which is the basis of medical artificial intelligence. And as the fourth industrial revolution gradually approaches reality, various occupational groups are becoming meaningless, as in the preceding industrial revolution, and in this paper we will learn about the impact of this situation on the medical community.

• 의학교육논단
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• 제23권3호
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• pp.154-159
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• 2021

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted all aspects of undergraduate, postgraduate, and continuing medical education. Only the focus of medical education-care for patients and communities-has remained an integral part of all of the above sectors. Several challenges have been experienced by learners and educators as the education and training of future doctors has continued in the midst of this crisis, including the cancellation of face-to-face classes and training, reduced patient encounter opportunities, fairness issues in online assessments, disruption of patient interview-based exams, reflections on the role of doctors in society, and mental health-related problems linked to isolation and concerns about infection. In response to these disruptions, educators and institutions have rapidly deployed educational innovations. Schools have adopted educational strategies to overcome these challenges by implementing novel education delivery methods in an online format, providing clinical experiences through simulation or telehealth methods, introducing online assessment tools with formative purposes, encouraging learners' involvement in nonclinical activities such as community service, and making available resources and programs to sustain learners' mental health and wellness. During the COVID-19 pandemic, educators and institutions have faced drastic changes in medical education worldwide. At the same time, the quantitative expansion of online education has caused other problems, such as the lack of human collaboration. The long-term effects of the COVID-19 pandemic on medical education need to be studied further.

• 한국보건간호학회지
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• 제11권2호
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• pp.57-72
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• 1997

The objectives of this study are : 1) To understand self-care ability, living habits, utilization patterns of medical facililties for the elderly in Puk-Cheju county which has the highest percent age of senior citizens among Cheju rural community: 2) To identify factors which influence living quality and long life for the eldely 3) To develop health care service with a view to guaranteering living quality The eldely population of Puk-Cheju county was $10.8\%$ in 1995. It will be increasing and is projeted $23.0\%$ by 2030. The result indicated that utilizations rate by out-patient were 5.89 claims and utilizations rate by in-patient were 0.17 claims per person. The highest disease among respondents were disease of musculoskeletal system and connective tissue. A total of 310 elderlys were responded to analyze self-care ability and health behavior. The most important factors of long life were to have peaceful mind$(50.0\%)$. The common disease of acute and chronic disease was musculoskeletal system disease. $66.8\%$ of respondents went to hospital and local clinic when they got sick. The most needed health care service was home visiting service among public health center, representing $31.4\%$. The repondent's self-care ability and self-efficacy were relatively superiority. A total of 92 elderlys were conducted the intelligence test for the rate of dementia and their average age was 74.3. The result of Minimental State Scale indicated that 25% of respondents were suspected to be dementia. The followings are recommendations based on the survey result. 1) Concidering every conditions of self-care ability and health status for elderly. It is important to embody appopriate health care service. 2) Considering concrete method, it is necessary to establish health service, which match health status and self-care ability, and various planning for sepecial facilities for the elderly. 3) It is desiable to make actual programs for the elderly in each community level. 4) It must be develop the better use of volunteers and programs for prevention of dementia. Finally, Concerning the orgarnization of public health center, community health center need to be reorganized for health service for the elderly. It is important to develop and operate health promotion for the elderly, and it is necessary to form the foundation for the support of facilities equipments. This contribute to promote health status for the rural elderly.