• Journal of Hospice and Palliative Care
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• 제4권2호
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• pp.137-144
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• 2001

목적 : 암환자에서 가장 흔히 겪게 되고, 심각한 증세는 통증이다. 진행성 암인 경우 $60{\sim}90%$의 환자들이 통증으로 고상하게 되며, WHO통계에 따르면 전세계적으로 4백만 정도의 암환자들이 통증으로 고생하고 있다. 통증관리원칙에 따르면 환자 $70{\sim}90%$이상에서 적절한 통증조절이 이루어질 수 있음에도 불구하고 이들 중 $60{\sim}70%$의 암환자들이 적절한 통증치료를 받지 못하고 있다. 본 연구는 1) 암환자의 통증 빈도 2) 환자와 담당전공의에서 통증인지의 일치 여부 3) 암환자의 통증치료에서 진통제 투약의 적절성 등을 조사함으로써, 암환자 통증에 대한 이해와 통증관리에 대한 지침을 마련하는데 기초자료를 제공하고자 하였다. 대상 및 방법 : 서울대학교병원 내과병동에 입원한 암환자들의 통증 빈도, 담당전공의와 환자의 통증인지 일치도, 통증 관리의 적절성 등을 평가하기 위해서 환자와 담당전공의를 대상으로 설문조사를 시행하고, 진료기록을 평가하였다. 결과 : 7일 이상 내과병동에 입원해 있는 암환자 59명중 43명(62.8%)이 통증을 호소하였다. 전공의들은 담당 암환자들의 통증을 실제보다 과소평가하고 있었으며, 진통제 투약 원칙이 지켜지지 않은 경우도 상당수 있었고, 환자의 통증이 심해질수록 통증에 대한 치료가 더 불충분한 경향이 있었다. 결론 : 암환자에 있어서 통증은 아직까지 낮게 평가되고 있으며 통증 치료는 여전히 불충분하다, 이와 같은 점을 고려할 때, 통증의 평가 및 치료에 대한 더 많은 교육이 필요할 것으로 생각된다.

• Journal of Preventive Medicine and Public Health
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• 제27권1호
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• pp.117-134
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• 1994

대구직할시 남구 1 개동 주민을 대상으로 도시 지역의료보험 실시 전후(이하 실시 전후)의 의료 이용양상을 파악하기 위하여 실시 6개월 전인 1989년 1월에 1차조사를 하였고, 실시 1년 6개월 후인 1991년 1월에 2차조사를 하였다. 1차조사의 대상자는 1,230가구 4,939명이 었으나, 2차추적조사가 가능했던 인구는 519가구 2,277명 (추적률:46.1%)이었다. 2차조사까지 추적이 가능했던 2,277명 중 1차 조사시 보험에 가입되지 않았던 240가구 1,033명을 코호트 I군(이하 I군)으로 하였고, 1차조사시 보험에 가입되었던 279가구 1,244명을 코흐트 II군(이하 II군)으로 구분하여 조사자료를 분석하였다. 인구 1,000명당 급성이환으로 인한 의사방문율의 변화는 실시 후에 I군에서 16.5 증가한 반면, II에서는 2.4만 증가하였으며, 만성이환에서도 I군이 13.5 증가하였으나 II군은 7.2만 증가하였다. 이환 및 활동제한 의료필요 충족률도 I군에서 실시 후 뚜렷히 증가하였다. 월가구소득별 급성이환에 의한 의료필요충족률은 I군에서 40만원미만군이 1.6으로 $40{\sim}99$만원군의 4.0과 100만원이상군의 49.3에 비해 월등히 낮았다. 이러한 소견은 나머지 조사대상군과 만성이환에서도 동일하였다. 급성과 만성이환자의 병원이용 이유는 유용성, 의원의 경우는 지리적 접근성이 실시전후모두에서 가장 많았고 약국이용 이유 중 실시 전에는 접근성과 의료비지불성이 중요하였으나, 실시 후에는 의료비지불성의 중요성은 상대적으로 감소하였다. 최근 15일간 의사방문여부를 종속변수로한 multiple logistic regression analysis에서 급성이환(+), 만성이환(+) 그리고 월가구소득(+)이 실시전후 모두에서 유의한 변수였다. 실시 후 부과된 보험료에 대한 불만족률이 두군 모두 지역의료보험 가입자에서 각각 81.0%와 74.1%로 타 의료보험가입자에 비해 월등히 높았다. 실시 후 병원과 의원의 의료비와 서어비스에 불만족스럽다고 응답한 사람이 I군에 비해 II군에서 더 많았다. 이상의 소견으로 의료보험이 실시됨으로 미충족의료수요를 감소시키는 효과를 가져왔으나 실시 후에도 저소득층의 의료이용률이 고소득층에 비해 여전히 낮아 의료보험실시로 경제적 장애가 감소하였음에도 불구하고 본인부담금 등으로 인한 경제적 장애와 의료기관을 방문하는데 소요되는 시간, 대기시간 등 의료이용을 저해하는 요인이 남아있어 의료이용의 형평이 사회계층들간에 완전히 이루어지지는 않았다. 특히 만성이환의 경우, 불균형이 심하였다. 또한, 부과된보험료에 대한 불만족도가 높아 현행 보험료선정기준의 재평가 및 공정성을 향상시킬 필요성이 제기되었다.

• Journal of Nutrition and Health
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• 제47권2호
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• pp.113-123
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• 2014

본 연구에서는 국민건강영양조사 중 2008~2010년 자료를 이용하여, 한국 성인 총 18,735명을 대상으로 혈청 비타민 D 수준에 따른 우울증과의 관계를 분석하였고, 그 결과는 다음과 같다. 1) 의사에게 우울증을 진단 받았다고 응답한 경우인 우울증에 대한 유병률은 남녀 각각 약 1.63%, 5.43%이었고, 의사에게 진단을 받지는 않았으나 우울관련 증상을 경험한 경우인 우울증상경험률은 남녀 각각 약 12.5%, 26.1%로 여성이 남성에 비해 우울증 및 우울증상을 경험한 비율이 더 높은 경향을 보였다. 2) 우울 상태에 따른 특성을 분석한 결과, 남녀가 유사한 패턴을 보였다. 즉, 남녀 모두에서 우울증 및 우울증상경험 그룹은 정상그룹에 비해 평균 연령이 더 높았으며, 직업을 가지고 있다고 응답한 사람의 비율은 더 낮은 결과를 보였다. 또한 우울증 및 우울증상경험 그룹이 정상그룹에 비해 소득 및 교육수준이 더 낮은 경향을 보였고, 현재 흡연을 하고 있다고 응답한 사람이 유의적으로 더 높은 결과를 보였다. 3) 혈청 25(OH)D 수준과 우울증 유병 위험간의 관계에 대하여 단계적으로 공변량을 보정한 후 다중로지스틱회귀분석한 결과, 남녀 모두 유의적인 결과를 보이지 않았으며, 동일한 모델을 이용하여 우울증상경험을 결과인자로 두어 분석한 결과에서도, 남녀 모두 비타민 D와 우울증상경험간의 유의적인 관계를 보이지 않았다. 또한, 우울상태에 따라 평균 혈청 25(OH) D 농도를 공변량을 보정한 후 다중선형회귀분석한 결과, 남녀 모두 그룹간의 유의적인 차이는 보이지 않았다. 본 연구에서는 비타민 D 수준에 따른 우울증 및 우울증상경험 위험률에 대하여 유의적인 관계를 보이지 않았으나, 일부 국외 선행연구 결과에서 비타민 D 수준과 우울증간의 유의적인 관계가 보고되고 있으며 이와 관련된 가능한 메커니즘이 제시되고 있다. 따라서, 한국인을 대상으로 명확한 인과관계를 규명하기 위하여 검증된 우울증 측정 도구를 이용한 전향적 코호트 연구 및 임상연구가 진행되어야 할 것이다.

• 한국환경보건학회지
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• 제42권6호
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• pp.396-408
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• 2016

Objectives: The purposes of this study were to determine the relationship between the prevalence of allergic diseases and urinary cadmium concentration among children from six to 12 years of age, and to evaluate the association between cadmium in urine and other immunologically related factors in two elementary schools with different environmental conditions. Methods: Data on physician-diagnosed prevalence over the past 12 months and potential risk factors for allergic disease were collected from survey results drawn from 236 children living in different regions (central urban vs. suburban) from April to July in 2014 by an ISAAC questionnaire. We analyzed cytokine levels in serum through enzyme-linked immunosorbent assay and urinary cadmium concentration by use of inductively coupled plasma mass spectrometry. Results: Concentrations of urinary cadmium in suburban and central urban children were $0.11{\pm}0.11ug/L$, $0.14{\pm}0.17ug/L$, respectively (p>0.05). Results from the analysis of the t-test and chi-square test showed that urinary cadmium levels were positively associated with environmental factors (paternal smoking status, passive smoking, traffic volume and experiences of outdoor odors) and individual genetic factors (parental allergic disease). Cadmium concentrations in urine were also positively associated with the prevalence of allergic disease and immune-related cytokines (eosinophils, IgE, IL-5, IL-33, IL-17). Conclusion: This study suggests that genetic factors (parental history of allergic diseases), environmental factors, and regional status (suburban and central urban) should be considered as probable factors increasing the concentration of urinary cadmium, which has the potential to influence the allergic disease prevalence of school-age children.

• Journal of Preventive Medicine and Public Health
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• 제27권4호
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• pp.747-761
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• 1994

Workers' periodic health examination is the main tools used to manage the health problems of most workers in Korea. The most common health problem found in workers' periodic health examination is liver disorder. Liver disorder is also one of the most common health problems in general population and one of the leading causes of mortality in adult population. Regulation proposed by government (No. 207, Ministry of Labor, 1992) defines the criteria for selection of workers with the liver dysfunction for further evaluative examination and the examination items used for diagnosis of the workers with liver dysfunction. This study was designed to evaluate the proficiency of each examination items presently defined in Regulation and propose the optimal examination items for detection of the liver disorders found by workers' periodic health examination. Study subjects are 186 workers with abnormal liver function tests in screening examination of workers' periodic health examination. Questionnaire survey including past history of liver disorder, drinking history, height and weight was done. Physical examination by physician, routine test items defined by Regulation (SGOT, SGPT, $\gamma$-GTP, protein, albumin, total and direct bilirubin, alkaline phosphatase, $\alpha$-feto protein, HBsAg and anti-HBs), anti-HCV antibody test and liver ultrasonography were done. Results are as follows; 1. Result of evaluative examination utilizing only the items defined in Regulation was; There were 75 workers with suspected live. disorder(40.3%), 63 with no liver dysfunction (33.9%), 13 with suspected hepatitis B(7.0%), 10 workers with hepatitis B(5.4%), 10 workers with hepatitis B carrier state(5.4%), 10 with alcoholic liver disorders(5.4%), 5 with fatty liver(2.7%). When alternative diagnostic criteria applying additional examination items (drinking history, body mass index, anti-HCV antibody and ultrasonography) diagnosability of liver disorder was increased. When all four items were included, final results were; 23 workers (17.8%) with hepatitis B (10 carriers, 13 suspects and 10 hepatitis B), 10 (5.4%) with hepatitis C(4 carriers, 5 suspects and 1 hepatitis C), 13(7.0%) with alcoholic liver disorder, 45(24.2%) with fatty liver (40 suspects, 5 fatty liver), 410%) with suspected liver disorders and 44 (23.7%) with normal liver. 2. Of examination items defined by Regulation, only SGOT, SGPT, $\gamma$-GTP and HBsAg were significantly different in abnormal rate and mean value, and all other laboratory findings did not showed significant difference between two groups. Drinking history, body mass index and anti-HCV antibody test which are the items that authors included in this study, also showed significant difference between two groups. Utilization of body mass index (BMI) for abnormal liver function group in diagnosis of fatty liver had high specificity (97.6%) but sensitivity (22.3%) was low. Therefore we suggest that SGOT, SGPT, $\gamma$-GTP, HBsAg, alcohol drinking history, BMI and anti-HCV Ab were useful for diagnosis of liver disorders among worker's periodic health examination.

• 지역사회간호학회지
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• 제5권2호
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• pp.130-146
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• 1994

Our medical care system is trying to diversify in order to meet the client's needs, and to adjust to a medical environment which is changing very rapidly. Because current nursing theory and practice focus on holistic care, health care management, education, and research, contrary to the traditional emphasis on only assisting a physician, more autonomy and specialization for the implementation of nursing are required. Considering these trends and actual needs, the category of clinical nurse specialist should be established as soon as possible. In order to develop strategies for implementing this new professional specialty, the authors conducted a field survey and literature review of the current system in Korea. As a result, various obstacles and constraints were discovered as follows : 1) There are few accredited educational programs for the training of CNS's. 2) Several hospitals already have staff designated as clinical nurse specialist (CNS) even though the term CNS is not yet standardized or adopted in nationwide. 3) The role of the CNS is not clearly understood by the medical societies, or even nursing societies. A nurse who works in specific nursing areas such as central supply, kidney dialysis, intensive care, coronary care, etc. for a long time, considers herself /himself a CNS. Based upon the above findings, the following alternatives are recommended. 1) The role of the CNS should be defined according to specified functions and authority : professional autonomy ; counselling and educating patients and their familes, nurses, and even other medical personnel ; research on improvement of nursing ; and management of the nursing environment including medical resources, information, and cases. 2) the qualification of CNS should be attained only by a nurse who has an RN license and clinical experience of more than 3 years in a specific nursing field: passes a qualifying examination; and contributes to the professional development of peers, colleagues, and others. A master's degree should only be optional, because of the insufficient of graduate programs which are well designed for the CNS. 3) The CNS should initially be a head nurse rather than line staff in order to deal with as wide an experience base as possible. 4) The nursing specialty could be divided into two areas such as a clinical field and a community field. The clinical field could then be categorized by the Styles' classification such as diseases and pathogenics, systems, ages, acuity, skills/techniques, and function/role ; the community field could be classified according to work site.

• 농촌의학ㆍ지역보건
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• 제42권2호
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• pp.79-86
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• 2017

우울증과 대사증후군은 상호 연관성이 있으며, 영양소 섭취 상태가 두 질환의 발생과 예방에 영향을 미침에도 불구하고 대사증후군 환자를 대상으로 한 우울증 환자의 영양소 섭취 상태에 대한 연구가 국내는 물론 국외에서도 적은 편이다. 이에 본 연구는 국민건강영양조사에 참여한 대사증후군 환자를 대상으로 우울증과 영양소 섭취 상태의 연관성을 알아보고자 하였다. 본 연구는 국민건강영양조사 자료 중 제 6기 2차 (2014년) 자료를 분석하였으며, 만 20세에서 60세 사이의 대사증후군 환자 1.471명 중 의사에 의한 우울증 진단여부가 확인이 되는 1,334명을 최종 대상자로 하여 이들의 영양소 섭취 상태와 우울증과의 연관성을 분석하였다. 대사증후군 환자를 남녀로 구분하여 우울증 군과 정상 군의 영양소 섭취 상태를 비교하였을 때, 니아신 섭취량이 남성에서 각각 $14.5{\pm}6.7mg$과 $17.8{\pm}9.7mg$으로 우울증 군이 유의하게(P=0.047) 낮았고, 여성에서도 각각 $11.4{\pm}5.4mg$과 $13.1{\pm}8.0mg$으로 우울증 군이 유의하게(P=0.025) 낮았다. 결론적으로 본 연구에서는 대사증후군이 있는 성인에서 우울증이 니아신 섭취량과 관련이 있음을 확인할 수 있었다. 이는 대사증후군 환자에서 우울증에 대한 영양소 섭취 상태 평가가 의미가 있음을 시사하며, 또한 영양학적 중재가 대사증후군 환자의 우울증 유병을 감소시킬 수 있을 것으로 생각된다.

• 한국병원경영학회지
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• 제1권1호
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• pp.108-135
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• 1996

This paper investigates the current feature of management strategy of hospitals in Korea, and examines the relationships between adoption of a particular strategic orientation and the hospitals environmental and organizational characteristics, strategic behaviors and management improvement activities, and financial performance. Data were collected from CEOs of 88 hospitals among 650 hospitals for a 13.5% response rate using the self-administered questionnaire by mail survey. The major findings that obtained are as follows: 1. Only 37.2% of response hospitals carried out strategic planning, Most of these hospitals established the first strategic planning in 1991(81.3%) and renovated strategic planning by 4 or 5 years(56.3%), and modified strategic planning with flexibility(59.4%). Most strategic plans were documented, but informalized(68.8%). And only 29.0% of these hospitals had independent planning division. 2. Hospital services that CEOs assessed rank ordered for their impact on profitability are as follows: i)diagnostic ultrasound facility, computerized tomography scanner, obstetric inpatient unit, therapeutic X-ray, and physical therapy at present. ii)diagnostic ultrasound facility, physical therapy, computerized tomography scanner, emergency department, and health screening at future. And the services rank ordered that CEOs hoped to introduce are as follows: emergency department, physical therapy, health screening, volunteer services, and computerized tomography scanner. 3. Using a typology developed by Miles and Snow(l978), the strategic orientation of response hospitals are shifting significantly from defenders in the past to analyzers in the present, and to prospectors in the future(p<.01). 4. With regard to hospital environmental and organizational characteristics such as ownership, physician training, location, bed size, and hospital management training career and specialty of CEOs, the four strategic orientation archetypes varied not significantly. But, hospitals with a analyser orientation in the present and a reactor orientation in the future perceived competition significantly higher than the other three archetypes(p<.05). 5. The four archetypes rank ordered in terms of appling strategic behaviors and management improvement activities are as follows: prospector, analyzer, reactor, and defender. 6. The four archetypes differed significantly in terms of their financial performance using revenue per bed(p<.05). Reactors and prospectors in terms of total revenue per bed, prospectors in terms of outpatient revenue per bed, and reactors and prospectors in terms of inpatient revenue per bed had the best performance.

• 대한한방내과학회지
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• 제13권1호
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• pp.61-69
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• 1992

In Nan-Gyung, showed that could know the lung condition taking pulse with the weight of three beans, the heart condition taking pulse with the weight of six beans, the spleen condition taking pulse with the weight of nine beans, the liver condition taking pulse with the weight of twelve beans, the kidney condition pressing to bone(骨). This theory is first suggested in Nan-Gyung(難經). In those case, the weight of three, six, nine, twelve beans and pressing to bone don't mean not the real weight but the relative weight(輕重) of taking pulse(按脈). In other words, those represent Boo Jung Chin(浮中沈), which are the conception of the upper, the meddle, the lower part(上中下). So, we could take pulse of the heart and the lung condition in Boo(浮), the spleen condition in Jung(中), and the liver and the kidney condition in Chim(沈). The heart and the lung pulse showed in the Boo(float level) must be seen with Boo-Mack(부맥 : float pulse), the liver and the kidney pulse showed in Chim (sinklevel) must be seen also with Chin-Mack(沈脈 : sink pulse). The result of the method of taking pulse of viscera with relative weight focused on the as pect of mornal pulse(平脈) and disease pulse(病脈) of five viscera in Mack-Gyung publeshed later than Nan-Gyung and special works which made a comprehensive survey the result is as follow. 1. In normal pulse of five viscera, the heart and the lunk pulse were shown with Boo-Mack(浮脈:float pulse) as the central figure, the liver's and the kidney's pulse were shown centering around Chim-Mack(沈脈: sink pulse) and the spleen's pulse was shown with Wan-Mack(緩脈) which is vital force of stomach(胃氣) and seen in only middle part. 2. In disease pulse of five viscera, frequently, the heart and the lung pulse was shown as Chim-Mack(sink pulse), the liver and the kidney pulse was seen as Boo-Mack (float pulse). 3. In the case of normal pulse. the method of taking pulse with relative weight in Nan-Gyung agree with the normal pulse of five viscera in Mack-Gyung. But in the case of disease pulse, they didn't correspond with the other. 4. So the method of taking pulse with relative weight in Nan-Gyung is not the exam pulse which ca be used in the clinical diagnosis but one of the feeling pulse way to bring in the conception of location of the visceras. 5. From now on, the method of taking pulse rdlated to relative weight need to be looked into minutely compared with later physician's theory than Mack-Gyung.

• Journal of Preventive Medicine and Public Health
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• 제10권1호
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• pp.3-15
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• 1977

In order to find out health problems among inhabitants in slum areas in Kwanak-Ku, Seoul, a series of health survey was conducted upon 510 households by interview from March to December, 1976. The results obtained were as follows: 1. Employments of householders were unstable; Out of 508 householders, 164(32.3%) were unemployed and 184 (36.2%) were daily or temporary employees. 2. Average number of households per house was 2.0 and average area of residential room per person was $4.0m^2$. 3. 476(93.3%) out of 510 households were supplied with tap water and rest of them made use of ground water as a source of drinking water. 4. Only 279(18.3%) out of 1527 live births were delivered at medical facilities, 496(32.7%) were at home attended by doctors or midwives and 358(25.1%) took prenatal care. The above findings were worse in urban slum area than in other urban area of relatively high economic level, but were better than in rural area of less medical facilities. 5. Initiation of treatment were delayed until their illnesses were advanced in most of the households, 472(92.5%) out 510. In the early stage of the illness, 131(25.6%) of the house-holds sought physicians in their clinics or general hospitals and 250 (40.9%) visited chemists, to toy drugs at first hand. Frequency of visits to physician increased to 52.8% as the disease aggravated in later stages. 6. Cost of medical expenditure per household amounted to 815 won, and was paid to, in the order of chemists, physicians, chinese herb stores, chinese herb doctors. 7. Concerning the health knowledge of the inhabitants, 273(53.9%) out of 506 respondents were aware of the infectivity of pulmonary tuberculosis, and 68(13.4%) of them checked regularly their chest findings by X-ray at least once every two years. 8. As for the family planning, although 448(87.3%) out of 510 respondents were in favor of it, 215 (41.8%) of them were actually practicing contraception. 9. About 40.6% (125 respondents) of them obtained information and knowledge concerning contraception through personal contact with family planning workers. 10. Nutritional status of housewives was generally poor: 49(38.3%) out of 128 housewives were found to be anemic and average serum protein level was $7.5{\pm}0.82g/dl$.