• 농촌의학ㆍ지역보건
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• 제15권2호
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• pp.97-106
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• 1990

1. Background Women's health and their involvement in health care are essential to health for everyone. If they are ignorant, malnourished or over-worked, the health &-their families as well as their own health will suffer. Women's health depends on broad considerations beyond medicine. Among other things, it depends upon their work in farming. their subordination to their families, their accepted roles, and poor hygiene with poorly equipped housing and environmental sanitation. 2. Objectives and Contents a. The health status of rural women : physical and mental complaints, experience of pesticides intoxication, Farmer's syndrome, experiences of reproductive health problems. b. participation in and attitudes towards housework and farming c. accessibility of medical care d. status of maternal health : fertility, family planning practice. induced abortion, and maternal care 3. Research method A nationwide field survey, based on stratified random sampling, was conducted during July, 1986. Revised Cornell Medical index(68 out of 195 items). Kawagai's Farmers Syndrome Scale, and self-developed structured questionnaires were used to rural farming wives(n=2.028). aged between 26-55. 4. Characteristics of the respondents mean age : 40.2 marital status : 90.8% married mean no. of household : 4.9 average years of education : 4.7 yrs. average income of household : \235,000 average years of residence in rural area : 36.4 yrs average Working hours(household and farming) : 11 hrs. 23 min 5. Health Status of rural women a. The average number of physical and mental symptoms were 12.4, 4.7, and the rate of complaints were 22.1%, 38.8% each. revealing complaints of mental symptomes higher than physical ones. b. 65.4% of rural women complained of more than 4 symptoms out of 9, indicating farmer's syndrome. 11.9 % experienced pesticide overdue syndrome c. 57.6% of respondents experienced women-specific health problems. d. Age and education of respondents were the variables which affect on the level of their health 6. Utilization of medical services a. The number of symptoms and complaints of respondents were dependent on the distance to where the health-care service is given b. Drug store was the most commonly utilized due to low price and the distance to reach. while nurse practitioners were well utilized when there were nurse practitioner's office in their villages. c. Rural women were internalized their subordination to husbands and children, revealing they are positive(93%) in health-care demand for-them but negative(30%) for themselves d. 33.0% of respondents were habitual drug users, 4.5% were smokers and 32.3% were alcohol drinkers. and 86.3% experienced induced-abortion. But most of them(77.6%) knew that those had negative effects on health. 7. Maternal Health Care a. Practice rate of contraception was 48.1% : female users were 90.9% in permanent and 89.6% in temporary contraception b. Induced abortions were taken mostly at hospital(86.3%), while health centers(4.7%), midwiferies(4.3%). and others(4.5%) including drug stores were listed a few. The repeated numbers of induced abortion seemed affected on the increasing numbers of symptoms and complaints. c. The first pre-natal check-up during first trimester was 41.8%, safe delivery rate was 15.6%, post-natal check-up during two months after delivery. Rural women had no enough rest after delivery revealing average days of rest from home work and farming 8.3 and 17.2. d. 86.6% practised breast feeding, showing younger and more educated mothers depending on artificial milk 8. Recommendations a. To lessen the multiple role over burden housing and sanitary conditions should be improved, and are needed farming machiner es for women and training on the use of them b. Health education should begin at primary school including health behavior and living environment. c. Women should be encouraged to become policy-makers as well as administrators in the field of women specific health affairs. d. Women's health indicators should be developed and women's health surveillance system too.

• 의료법학
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• 제20권1호
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• pp.133-162
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• 2019

소득이 늘어나고 의학수준이 높아지면서 전문 의료의 영역이 확대되었고, 의료기술 전반에 대한 국민의 신뢰가 높아지면서 비단 질병을 치료하는 경우 뿐 아니라 생활 속에서의 의료영역은 더욱 넓어지고 있는 추세이나 약물에 대한 남용이나 내성균의 등장으로 인해 여러 가지 문제점 들이 발생하는 것도 사실이다. 언론보도에서 접할 수 있는 병원에서의 감염사례 이외에도, 의료소송을 통하여 분쟁의 대상이 되는 병원감염의 사례는 적지 않은 것이 현실이다. 병원감염에 의한 의료소송에 있어서 병원 자체의 관리나 감독의 소홀을 물어 손해발생의 인과관계를 입증할 수 있다면 피해자의 보호의 수준이 한층 높아질 수 있을 것이다. 병원감염과 관련된 비교법적 고찰을 통해 이러한 문제에 대한 해결점을 찾아보고자 하였다. 특히 병원감염과 관련한 비교법적 검토로서 독일의 입법례는 진료계약을 민법상의 전형계약으로 정해 두고 있어 독일의 민법 규정을 살펴보는 것은 우리 법에게도 시사하는 바가 크다. 또한 프랑스의 특별법 '환자의 권리'를 향상시키고자 노력하였고 이에 따른 판례의 변화도 살펴 볼 수 있다. 마지막으로 미국의 판례상의 과실추정칙의 이론은 원고의 입증의 부담을 줄여주려는 시도로서 배심원제 하에서 적용될 수 있으나 주의의무 위반의 증거제시가 어렵고 침묵의 모의를 통하여 감정단의 증언조차 확보가 어려울 때 참고해 볼 수 있는 이론이 아닌가 생각한다. 본 논문은 병원감염의 의료소송과 관련 될 수 있는 문제들을 비교법적 측면에서 검토하여 증명책임의 완화와 관련하여 우리에게 어떤 시사점이 있는지 찾아보고자 하였다.

• 대한의료기공학회지
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• 제1권1호
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• pp.13-59
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• 1996

Dep. of Classics &Medical History, College of Oriental Medicint, Kyung Hee University Today, many people are more interested Today, many people are more interested in preventing the disease than curing it. Chi-Kung(氣功) is the way of Life-Cultivation(養生法) peculiar to the orient, it is reported in china that Chi-Kung has an excellent curative value not only in curing the disease but also in preventing it. But the full-scale study of Chi-Kung is not be made up to now in Korea, so I studied the developmental history of chinese Chi-Kung through the oriental medical books. From this study, I reached the following conclusions; 1. Chi-Kung is naturally derived from the self-preservation instinct to adapt oneself to circumstances of the nature, but in the investigation from the documentational records, it is originated in the treatment method of the Sam-Huang-O-Jae(三皇五帝) period to cure the abnormal circulation of the vital force and blood caused by damp(濕). 2. As the principle and the method of the Life-Cultivation of the Chun-Chu-Jeon-Kook(春秋戰國) period were recorded in Huang-Jae-Nai-Gyung(黃帝內經) detailly and the remedy examples by ancient Chi-Kung such as Tao-Yin(導引), Haeng-Chi(行氣) were presented, we considered that theoretical basis of the development of Life-cultivation and Chi-Kung study was furnished in that period. 3. A famous doctor, Hwa-Ta(華引) lived in Han dynasty, researched the theory and practice of Tao-Yin transmitted from the former generations, as that result, he formed a kind of medical, gymnastics what is called O-Keum-Hi(五禽?). It is considered that 'O-Keum-Hi' is a Tao-Yin method developed more practically and systemetically than the Tao-Yin appeared in the 'Jang-Ja'(莊子) or 'Hoy-Nam-Ja'(淮南子). 4. In Wui-Jin-Nambook-Jo(魏曺南北朝) periods, the contents of Chi-Kung were more abundant under the influence of Buddhism(佛敎) and Taoism(道敎). Galhong(葛洪), the author of 'Po-Bak-Ja'(抱朴子) arranged the ancient Chi-Kung method systematically first of all, Tao-Goeng-Gyung, the author of 'Yang-Seong-Yeun-Myung-Rok'(養性延命錄) recorded the 'Yook-Ja-Geul'(六字訣) first time. 5. There is a new development of Chi-Kung therapy in Soo-Tang-Odae(隋唐五代) periods, especially So-Won-Bang(巢元方), the author of 'Jey-Bang-Won-Hwu-Ron' collected almost all of the Chi-Kung method, for curing the disease formed before Soo(隋) period. From that fact, we supposed that Chi-Kung was utilized more widely in curing the disease. 6. 'So-Ju-Cheon-Hwa-Hu-Peob'(小周天火候法) was adopted as the best orthodox approach under the influence of Nae-Tan-Taoist(道敎內丹學波) in Song-Keum-Won(宋金元) periods, especially in the song dynasty, 'Pal-Dan-Geum'(八段錦) was appearde and assignment of six-Chi(六氣) for bowel and viscera in the 'Yook-Ja-Geul'(六字訣) was decided firmly, that is to say Lung-Si(肺-?), Heart-Kha(心-呵), Spleen-Hoa(脾-呼), liver-Hoe(肝-噓), Kidney-chui(賢-吹), Three-Burner-shi(三焦-?). 7. In Myung-Cheong(明淸) periods, The general practitioner applied the principle of 'Byun-Jeng-Ron-Chi(辨證論治) to the Chi-Kung field, and after Myung dynasty the style of doing 'Yook-Ja-Gyel'(六字訣) was developed to the moving style. 8. Today, in china, the study on the Chi-Kyung is being progressed constantly under the positive assistance of government, Chi-Kung-Hak(氣功學) has taking its place as a branch of study step by step. It is considered that the establishment of Chi-Kung-Hak Classroom(氣功學敎室) and Medical Chi-Kung Center(氣功療法室) for special and systematic research are needed, at the same time the settlement of institutional system for training the Chi-Kung technician(氣功師) is also needed.

• 대한한의학원전학회지
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• 제4권
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• pp.19-73
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• 1990

Today, many people are more interested in preventing the disease than curing it. Chi-Kung (氣功) is the way of Life-Cultivation (養生法) peculiar to the orient, it is reported in china that Chi-Kung has an excellent curative value not only in curing the disease but also in preventing it. But the full-scale study of Chi-Kung is not be made up to now in Korea, so I studied the developmental history of chinese Chi-Kung through the oriental medical books. From this study, I reached the following conclusions ; 1. Chi-Kung is naturally derived from the self-preservation instinct to adapt oneself to circumstances of the nature, but in the investigation from the documentational records, it is originated in the treatment method of the Sam-Huang-O-Jae (三皇五帝 )period to cure the abnormal circulation of the vital force and blood caused by damp (濕). 2. As the principle and the method of the Life-Cultivation of the Chun-chu-Jeon-Kook (春秋戰國) periods were recorded in Huang-Jae-Nai-Gyung (黃帝內徑) detailly and the remedy examples by ancient Chi-Kung such as Tao-Yin (導引), Haeng-Chi (行氣) were presented, we considered that theoretical basis of the development of Life-cultivation and Chi-Kung study was furnished in that period. 3. A famous doctor, Hwa-Ta (華陀) lived in Han dynasty, researched the theory and practice of Tao-Yin transmitted from the former generations, as that result, he formed a kind of medical gymnastics what is called O-Keum-Hi (五禽戱). It is considered that 'O-Keum-Hi' is a Tao-Yin method developed more practically and systemetically than the Tao-Yin appeared in the 'Jang-Ja' (莊子) or 'Hoy-Nam-Ja' (淮南子). 4. In Wui-Jin-Nambook Jo (魏晋南北朝) periods, the contents of Chi-Kung were more abundant under the influence of Buddhism (佛敎) and Taoism (道敎). Galhong (葛洪), the author of 'Po-Bak-Ja' (抱朴子) arranged the ancient Chi-Kung method systematically first of all, Tao-Goeng-Gyung (陶宏景), the author of 'Yang-Seong-Yeun-Myung-Rok' (養性延命錄) recorded the 'Yook-Ja-Geul' (六字訣) first time. 5. There is a new development of Chi-Kung therapy in Soo-Tang-Odae (隋唐五代) pefiods, especially So-Won-Bang (巢元方), the author of 'Jey-Byung-Won-Hwu-Ron' (諸病源候論) collected aimost all of the Chi-Kung method, for curing the disease formed before soo (隋) period. From that fact, we supposed that Chi-Kung was utilized more widely in curing the disease. 6. 'So-Ju-Cheon-Hwa-Hu-Peob' (小周天火候法) was adopted as the best orthodox approach under the influence of Nae-Tan-Taoist (道敎內丹學派) in Song-Keum-Won (宋金元) periods, especially in the song dynasty, 'Pal-Dan-Geum' (八段錦) was appeared and assignment of six-Chi (六氣) for bowel and viscera in the 'Yook-Ja-Geul' (六字訣) was decided firmly, that is to say Lung-Si (肺-呬), Heart-Kha (心-呵), Spleen-Hoa (脾-呼), Liver-Hoe (肝-噓), Kidneychui (賢-吹), Three-Burner-shi (三焦-嘻). 7. In Myung-Cheong (明淸) periods, The general practitioner applied the principle of 'Byun-Jeng-Ron-Chi' (辨證論治) to the Chi-Kung field, and after Myeong dynasty the style of doing 'Yook-Ja-Gyel' (六字訣) was developed to the moving style. 8. Today, in china, the study on the Chi-Kung is being progressed constantly under the positive assistance of government, Chi-Kung-Hak (氣功學) has taking its place as a branch of study step by step. It is considered that the establishment of Chi-Kung-Hak Classroom (氣功學教室) and Medical Chi-Kung Center (氣功療法室) for special and systematic research are needed, at the same time the settlement of institutional system for training the Chi-Kung technician (氣功師) is also needed.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.