• 제목/요약/키워드: Quality Management system

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설비공학 분야의 최근 연구 동향 : 2010년 학회지 논문에 대한 종합적 고찰 (Recent Progress in Air-Conditioning and Refrigeration Research : A Review of Papers Published in the Korean Journal of Air-Conditioning and Refrigeration Engineering in 2010)

  • 한화택;이대영;김서영;최종민;김수민;권영철;백용규
    • 설비공학논문집
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    • 제23권6호
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    • pp.449-469
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    • 2011
  • This article reviews the papers published in the Korean Journal of Air-Conditioning and Refrigerating Engineering during 2010. It is intended to understand the status of current research in the areas of heating, cooling, ventilation, sanitation, and indoor environments of buildings and plant facilities. Conclusions are as follows. (1) Research trends of thermal and fluid engineering have been surveyed as groups of general thermal and fluid flow, fluid machinery, and new and renewable energy. Various topics were presented in the field of general thermal and fluid flow. Research issues mainly focused on the thermal reliability of axial fan and compressor in the field of fluid machinery. Studies on the design of ground source heat pump systems and solar chemical reactors were executed in the field of new and renewable energy. (2) Research works on heat transfer area have been reviewed in the categories of heat transfer characteristics and industrial heat exchangers. Researches on heat transfer characteristics included heat transfer in thermoelectric cooling/power generation systems, combined heat and power systems, carbon nano fluid with PVP, channel filled with metal foam and smoke ventilation in a rescue station of a railroad tunnel. Also the studies on flow boiling of R123/oil mixture in a plain tube bundle and R410A charge amount in an air cooled mini-channel condenser were reported. In the area of industrial heat exchangers, researches on plate heat exchanger, shell and tube heat exchanger, enthalpy exchanger, micro channel PCHE were performed. (2) Research works on heat transfer area have been reviewed in the categories of heat transfer characteristics and industrial heat exchangers. Researches on heat transfer characteristics included heat transfer in thermoelectric cooling/power generation systems, combined heat and power systems, carbon nano fluid with PVP, channel filled with metal foam and smoke ventilation in a rescue station of a railroad tunnel. Also the studies on flow boiling of R123/oil mixture in a plain tube bundle and R410A charge amount in an air cooled mini-channel condenser were reported. In the area of industrial heat exchangers, researches on plate heat exchanger, shell and tube heat exchanger, enthalpy exchanger, micro channel PCHE were performed. (3) Refrigeration systems with alternative refrigerants such as hydrocarbons, mixed refrigerants, and CO2 were studied. Performance improvement of refrigeration systems are tried applying various ideas of refrigerant subcooling, dual evaporator with hot gas bypass control and feedforward control. The hybrid solar systems combining the solar collection devices with absorption chillers or compression heat pumps are simulated and studied experimentally as well to improve the understanding and the feasibility for actual applications. (4) Research trend in the field of mechanical building facilities has been found to be mainly focused on field applications rather than performance improvements. Various studies on heating and cooling systems, HVAC facilities, indoor air environments and energy resources were carried to improve the maintenance and management of building service equipments. In the field of heating and cooling systems, papers on a transformer cooling system, a combined heat and power, a slab thermal storage and a heat pump were reported. In the field of HVAC facilities, papers on a cooling load, an ondol and a drying were presented. Also, studies on HVAC systems using unutilized indoor air environments and energy resources such as air curtains, bioviolence, cleanrooms, ventilation, district heating, landfill gas were studied. (5) In the field of architectural environment and energy, studies of various purposes were conducted such as indoor environment, building energy, renewable energy and green building. In particular, renewable energy and building energy-related researches have mainly been studied reflecting the global interest. In addition, many researches which related the domestic green building certification of school building were performed to improve the indoor environment of school.

가정학교육과 취업방안연구 (A Study on Home Economist Education with Refrence to the Business Activities in Korea)

  • 한상순
    • 대한가정학회지
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    • 제27권2호
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    • pp.163-185
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    • 1989
  • Korean home economics education has around 100 years history. The main aims of home economics education up 1950 had not been changed, they were mainly for the improvement of household-skill to raise both standard of living and life quality as well as womanhood. After 1960's the standard of living drastically improved and the industrialization of Korean society was quite rapidly proceeded from simple to complex one. Because of these changes, I considered that the aims and the contents of home economics education should be reexamined and reshaped. This study motivated me that especially home economics major should be trained to be competent enough to work in industrialized society as much as the input to her college education. As industialization was made progress, family member's diverse role differentiation also occurred from past simple role such as house wife or girl's high school teacher among by home economics major. In this current societal change, most of the home economics major have wish to have opportunities obtaining new kinds of employment rather than obtaining merely teaching work. With this in mind I made a study on college level home economics education of the new adjustment to current and future industrialized Korean society. (1) The full number of officially admissible home economics major in 169 Korean colleges, 70 junior colleges, and one open university were as follows, 7139, 6080, and 230 respectively. The percentages of employed of employed numbers of them for the college and junior college graduates were 26.5 and 39.0 respectively. (2) The certificate qualifications issued to college home economics major are nutritionist (1st grade and 2nd grade), clothes and textilist, home economics teacher (2nd grade for high school) and kindergartener (2nd grade), The qualifications are certified after majoring each field from major departments of college of home economics by Ministrys of Labour and Education of the Korean government. The percentages of their employment are low as mentioned earlier. (3) To find out new employment opportunity for home economics graduates in home economist in business (henceforce/HEIB) status quo of consumer division for mational enterprise was surveyed. According to govermment decree of general law of consumer protection (1980), enterprise should organize bureau (offics, subdivision) on liability to consumer's complaint. Of 89.6% of the enterprise established th subdivision in which 96.2% of employee was male (3.8% was female). Of the employee college graduate and high school graduate were 93.2% and 6.8% respectively. On the employee's major acadmic backgroud (%), economics and business administration, engineering and low-political science were 39.5, 26.2 and 11.2 respectively. (4) To study on the relation between home economics and home economist in business, the aspect of historical development of HEIB, group of HEIB employing enterprise and their nature of business were tried to find out as well as perception and evaluation by enterprise on HEIB. (a) In the united States of America employed home economics major to enterprise was organized autonomously HEIB subdivision within American Home Economics Association since 1920's and the membership of HEIB was 3,000 of the AHEA membership 50,000. (b) In Japan the Japanese founder HEIB had three times the bilateral congress with the U.S.HEIB and had 10th anniversary celebration in 1988. Japanese HEIB member are not necessary to be home economics graduates but should have certificate as consumer adviser effected by the Minister of Trade and Industry. Japanese subdivision of consumer affaire within Japanese enterprise employ the consumer adviser with the certificate. Because of this different system from the United Sates, Japanese HEIB call their title "HEEB" instead of HEIB. The Japanese consumer adviser certificate system had initiated since 1980 and it belongs to 2nd level national qualification certificate. Currently active membership of Japanese "HEEB" association had increased from 115 (in 1979) to 319 in 1988. (5) For the opening of the future new employment of home economics graduates to enterprise and qualification required for the HEIB by national enterprise in Korea, I studied on the courses which seem to be important and required by employee in the field of HEEB in the United States of America and preliminary curriculum for home economics related major student aimning to be the future "HEEB" by Japanese HEEB study group of Japanese Association of Home Economics. It is suggested that it is very important and urgent to realize as home economics educator to have common deep concern and endeavors on opening new employment for our home economics major student1), we should try to publicize strongly and let enterprise and consumer protection board realize that employee in the subdivision of consumer protection should be the one who well experienced home economics major graduates2), we, home economics educator, should try to develop actively new curriculum in line of the suggestion made earlier for our future home economics major student of open broadly their future employment opportunities3), we, home economics educators, should try to have consensus on whether we should have support from government in terms of receiving national qualification certificate on consumer pretection or not4), and I would appreciate if the Korean Home Economics Association and Korean Home Management Society paydeep and positive concern on this matter.

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첩약의 보험급여 적용을 위한 과제 및 접근방안에 대한 연구 (A Study of Task and Approach for the Insurance Fee Application of Packed Medical Herbs)

  • 박용신;조병희;김호;이시백
    • 대한예방한의학회지
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    • 제7권1호
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    • pp.17-28
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    • 2003
  • We met results like the followings through the literatures and questionnaires about the tasks and solutions about the insurance fee of packed medical herbs. 1) It's turned out that 74.8% of herb doctors agrees to the insurance fee of packed medical herbs. However, in comparison with the same survey of the herb doctor association the percentage of general approval went somewhat lower, and especially the percentage of 'positive approval' became notably lower$(43.7%{\rightarrow}26.5%)$ and the percentage of 'active objection' raised about 2 times$(6.8%{\rightarrow}12.9%)$. Inquiring into the approval reasons on the insurance fee application of packed medical herbs some heads such as 'development toward treatment medical science' and 'decrease of publics burden' were higher than the one of 'management income and expenditure.' 2) As a result of the research, 36.0% of the patients and 42.8% of the residents recognized that the pay range of Chinese herb health insurance is narrow. They recognized that less people have the experiences of Chinese medical hospital use and internal application of the packed medical herbs as they are older, men rather than women. 85.4% of the patients and 74.9% of the residents agreed on the insurance pay of packed medical herbs. It's shown that they agree on the Chinese medical hospital use more as the economic standard is lower, on the insurance pay as they have ever taken the packed medical herbs. In the aspect of increase of insurance fee, 66.7% of the patients and 44.3% of the residents agreed on the insurance pay of packed medical herbs, and 18.1% and 36.1% disagreed on the insurance pay of packed medical herbs. The main objective reason why they disagree on the insurance pay of packed medical herbs was 'because the insurance fee goes up higher,' which answered 95.2% of the patients and 78.8% of the residents. 7.22% of the patients and 1.80% of the residents answered that they can pay more insurance fee in case of the insurance pay of packed medical herbs. However, in the priority order of the insurance pay, it hold the 5th position between 2 target research groups which was less than medical examination, charges for hospital accommodation and taking MRI. 3) According to the result of analysis about the cost of packed medical herbs, current practice price is 115,000 won and the average prime cost of a packed medical herb is 73,000 to 106,000 won. It's examined that the herb doctors regard that 95,000 won will be reasonable when the packed medical herb is payed in insurance. However, it was found out that the public generally thinks that the price would be appropriate on the level of 30,000 to 40,000 won and the percentage of the answers of 20,000 won to 30,000 was fairly high. 4) the central system of a prescription should be change into the central system of demonstration and the sick and wounded. 5) To solve this problem, the government should regulate it to pass by the circulation gradation of [importer, $peasantry{\rightarrow}manufacturer{\rightarrow}wholesaler{\rightarrow}distributor$(Chinese medical hospital, pharmacy dispensary of Chinese medicine)]And it should intervene into the quality and the circulation steps of Chinese medicine through 'the office or organization which is in charge of certification of Chinese medicine' and 'the office or organization which is in charge of the circulation of Chinese medicine.' And some actions such as simple severance, lavation, drying should be included into the conception of manufacture and the boundary between food and medical supplies should be made at a manufactory. And the regulation of standardized goods at one's own house should be improved so that, the peasantry can sell the materials of Chinese medicine only to the manufacturer. 6) In company with the insurance pay of packed medical herbs, the study about the separation of dispensary from medical practice in the Chinese medicine should be accomplished.

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과학영재학교에서의 AP(Advanced Placement)의 경험과 의미: 대학생이 된 영재학교 졸업생들과의 심층인터뷰를 중심으로 (Experiences and Meaning of AP (Advanced Placement) at the Specialized Schools for the Highly Gifted: Through the In-depth Interview with the AP Participants)

  • 한기순;최호성
    • 영재교육연구
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    • 제24권6호
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    • pp.1001-1024
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    • 2014
  • 본 연구에서는 과학영재학교에서 AP(Advanced Placement)를 경험하고 현재 대학생이 된 39명의 영재고 졸업생들과의 심층인터뷰를 통해 영재학교에서 운영 중인 AP의 운영실제 및 그 의미를 탐색하고 2015년부터 과학고로의 전면적 확대를 앞두고 있는 AP의 향후 방향성을 모색해보고자 하였다. 현재 영재학교 학생들은 기초필수와 선택과목 등으로 평균 8과목 이상의 AP 과목을 수강하고 있었다. AP 교과목의 경우, 대개는 영재학교 2학년부터 수강이 이루어지는 것이 일반적이나 PT(placement test)를 통해 1학년 때부터 AP과목을 수강하는 경우도 있었다. AP로 제공되는 선택과목들은 전공별로 차이가 있어 수학 교과에서는 비교적 많은 전공 선택 과목이 제공되고 있으나 생물이나 전산 교과등을 이수하려는 학생들에게는 상대적으로 선택의 폭이 적었다. 본 연구에 참여한 학생들에 의하면 영재학교에서의 AP는 오히려 대학에서의 수업보다 내용상 더 어려웠으며 소수인원으로 진행되는 만큼 활발한 교사-학생 상호작용과 함께 충실하게 운영되었다. 하지만 AP 과목의 이수 인정 학점인 C+의 타당성과 관련해서는 상이한 의견이 제시되었다. 연구결과 학생들은 AP로 단축된 시간을 다양한 측면으로 활용하고 있었다. AP가 0.5년에서 1.5년의 조기졸업을 위한 통로로도 활용되어지지만, 학생들은 AP로 단축된 시간을 복수전공, 부전공, 해외 교환학생 등과 같이 다양한 기회로 활용하고 있음을 알 수 있었다. 특히 남학생들의 경우 AP로 인해 단축된 시간이 있어 군복무 기간에 대해 다소 부담감을 덜 느끼는 것을 알 수 있었고, AP가 학생 개개인 관심사나 연구를 위한 시간적 여유를 제공해주기도 하였으며, 무엇보다 AP를 통해 고등학교에서 보다 진지하게 진로를 탐색하고 경험할 수 있는 유용한 시간이었다고 학생들은 지적한다. 본 연구는 과학영재학교와 과학고등학교에서 AP 과정이 성공적으로 정착하고 더욱 확대 발전하기 위해서 학교-대학 간의 보다 원활한 행정시스템 개선, AP 과목 인정 대학의 확대 등을 포함한 몇 가지 현실적 제언을 제시하고 있다.

도시공원(都市公園)의 속성(屬性)과 문제점(問題點) (Attitudes and Problems of Urban Parks, in Taegu City, Korea)

  • 최석주
    • 한국지역지리학회지
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    • 제2권2호
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    • pp.205-217
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    • 1996
  • 본 연구에서는 대구시 도시공원의 소요량과 현황을 시기별, 지역별, 규모별로 고찰하여 도시공원의 속성을 구명하고자 한다. 그리고 도시공원 개발에 있어서의 문제점과 앞으로의 개선방안을 모색하고자 한다. 현재의 공원율은 대구시(大邱市) 외곽의 큰 산(山)이 있는 동구(東區), 수성구(壽城區), 남구(南區)에서 높게 나타나고 있다. 이것은 대구의 근교 큰 산들이 자연공원(自然公園), 도시자연공원(都市自然公園)으로 지정되어 있기 때문이다. 결국, 근교의 산(山)이 없고 시계(市界)와 접하지 않은 중구(中區), 서구(西區)에서는 면적이 작은 근린공원과 어린이공원으로 구성되어 있다. 그러나 대구시의 공원, 유원지가 지역적으로 편중되어 있으나 공원간의 연관 관례를 정립하면 녹지계통의 연결이 가능하다. 도심 공원의 조성에 있어서 대구시(大邱市)에는 많은 이전적지(移轉跡地)가 민간부문에 의하여 토지의 소유권과 개발권이 전용되고 있다. 이전적지에 대해 당국에서는 도시 전체적 측면의 종합적 계획 및 검토, 이전적지에 대한 이용에 관해서 시민 의사를 적극적으로 반영하여 도시공간(都市空間)을 효율적으로 개발해야 할 것이다. 도시공원(都市公園)은 도시속의 녹지지점(綠地據點)으로서 도시가 팽창하고 인구가 증가하여 도시환경(都市環境)이 과밀화 될수록 그 중요성은 더욱 증대될 것이다. 따라서 도시공원의 조성(造成)은 형태와 규모에 관계없이 도시생활(都市生活)의 질(質)을 향상 시킬 수 있는 방향으로 나아가야 할 것이다. 도시공원은 주민사회(住民社會)에 있어서 반드시 있어야 할 개방된 공간으로 고려되어야 한다. 현대도시의 개발(開發)과 관리(管理)에 있어서도 도시민(都市民)을 위한 도시민에 의한 도시민의 공간이라는 철저한 인식하에서 이루어져야 한다. 공설과 공공(公共)공간은 누구나 이용할 수 있는 도시의 마당과 같은 것이며, 따라서 공원(公園)은 구미에서 도입된 계획이론과 이념의 차원보다도 우리의 공권(公園)답게 꾸며지고 이용 되어야 한다.

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소규모 개발사업의 저영향개발(LID) 사전협의 제도 도입 연구 - 비용편익 분석을 중심으로 - (A Study on The Introduction of LID Prior Consultation for Small-Scale Development Projects - Focusing on Cost-Benefit Analysis -)

  • 지민규;사공희;주용준
    • 청정기술
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    • 제26권2호
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    • pp.151-157
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    • 2020
  • 급격한 도시화는 국토의 불투수면을 증가시켜 도시형 홍수의 위험성을 가중시켜왔고, 지하수위의 저하, 수질오염물질 증가 등 환경재해 및 환경오염 문제를 유발시키고 있다. 국내에서는 이러한 환경적 영향을 최소화하고 개발 이전의 물순환 건전성을 유지하기 위해 저영향개발 기법을 도입하여 적용하고 있지만, 소규모 개발사업의 대부분은 강우유출량 관리의 법적 근거가 부재하여 사각지대에 놓여 있다. 이에 빗물의 표면 유출을 증가시키는 소규모 개발사업 또한 오염원인자 책임 원칙에 따라 저영향개발 시설의 적용을 의무화하는 것이 요구되며 이를 위해 물순환 회복 사전협의 제도를 도입하는 것이 필요하다. 본 연구는 소규모 개발사업의 저영향개발기법 도입을 가정하여 비용편익 분석을 중심으로 수행되었다. 비용·편익 분석에 필요한 전국 소규모 개발 대상사업의 규모 및 건수는 『건축법』에 따른 대지면적이 1,000 ㎡ 이상 이거나 건축연면적 1,500 ㎡ 이상의 건축물에 서울시의 실제 사전협의 통계자료를 적용하여 도출하였다. 피규제 기업·소상공인, 피규제 이외 기업·소상공인·일반국민 및 정부를 대상으로 소규모 개발사업의 저영향개발 시설물 설치에 따른 비용·편익을 분석한 결과, 경제성의 기준 값인 1보다 많이 낮은 것으로 확인되었으며 이는 대상사업의 규모 대비 시설물의 설치 비용이 높기 때문으로 사료된다. 하지만 저영향개발 시설의 설치에 따른 수환경 및 대기질 개선 등의 환경적 가치와 하수처리시설 운영비 절감 등의 공공성을 고려하면 향후 소규모 개발사업의 사전협의제도 도입은 필연적이다. 앞으로 소규모 개발사업의 사전협의 제도 도입과 함께 비용·편익을 개선하기 위해서는 지자체의 제도적, 재정적 지원이 적극적으로 요구된다.

우수한 1급 응급구조사 인력 양성 및 배출을 위한 정책 제안 (Policy suggestions to educate and produce outstanding paramedics in Korea)

  • 최은숙;고봉연;박희진;김효식;권혜란;최혜경;이경열;윤종근;홍성기;조근자
    • 한국응급구조학회지
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    • 제22권1호
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    • pp.7-19
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    • 2018
  • 연구 목적: 본 연구는 우수한 1급 응급구조사 인력 양성 및 배출을 위해 응급구조사의 역량을 도출하여 교육제도를 재정립하고 국가시험 및 자격제도를 개선하기 위한 정책 제안을 하고자 하였다. 연구 방법: 본 연구는 전문가 회의 및 설문지를 이용하였다. 설문 자료는 교육 전문가(응급구조학과 대학교수)와 현장 전문가(소방 119구급대원 및 병원에 근무하는 1급 응급구조사) 총 277명으로부터 수집되었으며, 자료수집 기간은 2016년 9월 7일부터 9월 20일까지였다. 수집된 자료는 SPSS 22.0을 이용하여 분석하였다. 연구 결과: 1급 응급구조사 교육과정 강화를 위해 표준교육과정안으로 총 27과목 94학점을 제안하였고 1급 응급구조사의 핵심역량 9가지를 도출하였다. 국가 자격시험은 필기시험 과목을 통합하는 방안과, 실기시험에 시나리오형의 문제를 추가하고, 실기를 절차대로 수행하는 단순실기시험에 낙제기준(critical criteria)를 적용하며, 실기시험은 통과/실패만 결정하는 것을 제안하였다. 또한 1급 응급구조사의 보건의료적 업무특성을 반영하여 자격은 면허로 바꾸는 것을 제안하였다. 결 론: 본 연구 결과를 토대로 표준교육과정 운영으로 핵심역량을 갖추고 배출된 인력들이 신뢰성 있는 국가시험제도를 통해 자격을 취득하고 1급 응급구조사로서 전문성을 강화할 수 있는 자격관리제도가 선순환을 이룰 때 우리나라 응급의료서비스의 질적 수준이 향상될 것이다.

네팔의 포용적 비즈니스 프로그램 평가에 관한 연구: 경제협력개발기구 개발원조위원회 평가기준 적용을 중심으로 (A Study on the Evaluation of Nepal's Inclusive Business Solution: Focusing on the Application of OECD DAC Evaluation Criteria)

  • 김연홍;이성순
    • 한국콘텐츠학회논문지
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    • 제21권4호
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    • pp.177-192
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    • 2021
  • 경제협력개발기구 개발원조위원회에서는 국제적으로 통용되는 공적개발원조위원회 5대 평가기준 개편에 대하여 논의하고 1991년 공적개발원조 평가 시 적절성·효율성·효과성·영향력·지속가능성 등 5대 평가 기준의 적용을 권고한 바 있다. 본 연구는 2019년부터 네팔에서 시행 중인 포용적 비즈니스 프로그램의 평가에 있어 경제협력개발기구 개발원조위원회 평가기준을 적용하여 분석하고 개선과제를 도출하는데 있다. 연구 방법은 네팔 현장조사와 포커스 그룹 미팅 방법을 적용하였다. 연구 결과 네팔 포용적 비즈니스 프로그램의 적절성은 장애인, 고아 여성 등 취약계층 대상 지속적인 고용과 일자리 창출에 부합되었고 특히, 한국의 시각적 특수효과에 대한 수요가 증가하는 시점인데다 네팔 취약계층 대상 컴퓨터 그래픽 전문교육을 통한 인력양성이라는 점에서 프로그램이 적정하다고 볼 수 있다. 효율성은 작업지시와 작업컨펌 등의 과정이 전자식 관리 툴로 이루어지고 결과물의 납품이 온라인으로 전송되어 타업종에 비해 시간과 비용이 절감된다는 점에서 효율적이라고 할 수 있다. 효과성은 본 사업이 네팔의 장애인, 고아 여성 등 취약계층 대상 컴퓨터 그래픽 전문교육을 실시하고 수료생을 직원으로 채용하는 등 양질의 일자리를 제공한 점에서 효과성이 있는 프로그램이라고 할 수 있다. 지속가능성은 코이카 포용적 비즈니스 프로그램이 기존 농업, 제조업의 분야에서 종사하는 취약계층들로 하여금 컴퓨터 그래픽 업종에 종사하게 한 점과 영화, 캐릭터, 교육사업의 확장성, 타국가의 롤모델이 될 수 있는 점에서 지속가능성이 있다고 볼 수 있다. 향후 공적개발원조의 규모가 증가할 것을 고려한다면 체계적인 모니터링 시스템과 환류체계의 구축 등 공여국과 수원국 양국간 사업의 지속방안 마련이 요구된다.

종양인공관절 주위 골절의 피질골 지주 중첩 동종골 이식술 유무에 따른 결과 비교 (Periprosthetic Fracture around Tumor Prosthesis, Comparison of Results with or without Cortical Strut Onlay Allograft)

  • 김용성;조완형;송원석;이규평;전대근
    • 대한정형외과학회지
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    • 제56권1호
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    • pp.42-50
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    • 2021
  • 목적: 종양인공관절 주위 골절은 안정된 고정의 어려움과 골유합 후에도 골질 약화로 해리 및 재골절 위험이 많다. 피질골 지주 중첩 동종골 이식술을 종양인공관절 주위 골절에 적용하면 내고정도 쉽고, 골유합 기간도 단축되며, 합병증도 줄일 수 있을 것이라고 생각하였다. 본 연구는 종양인공관절 주위 골절 27예(30 골절)의 골절의 양상과 치료 후 재건 술식에 따른 생존율 및 합병증, 중첩 동종골 이식술 추가 여부에 따라 골유합 기간 및 기능적 결과가 차이가 있는지 분석하였다. 대상 및 방법: 골절 치료 시 판형 동종골 이식을 한 군 16예와 시행하지 않은 군 14예를 비교하였다. 분석항목은 종양인공관절 치환술부터 골절까지 기간, 골절의 양상, 골유합 기간 차이, 합병증, 및 기능적 결과를 기술하였다. 결과: 골절 양상은 unified classification system (UCS) B형이 21예(70.0%, 21/30)로 가장 많았으며 그 중 B1이 14예(46.7%, 14/30), B2가 1예(3.4%, 1/30), B3가 6예(20.0%, 6/30)였고 C형이 9예(30.0%, 9/30)였다. Kaplan-Meier 법에 의한 30 재건 부위의 5년, 10년 생존율은 각각 84.5%±4.18%, 42.2%±7.83%였다. 전체 30예의 골유합 기간은 평균 5.1개월(범위, 2.0-11.2개월)이었다. 동종골 이식군은 평균 3.5개월(범위, 2.0-6.26개월)로 고식적 고정군의 평균 7.2개월(범위, 4.0-11.2개월)보다 짧았다(p<0.0001). 최종 기능평가상 동종골 이식군은 평균 26.1점으로 고식적 고정군의 평균 20.9점보다 높았다(p<0.0001). 합병증은 4예로 모두 동종골을 사용하지 않은 군에서 있었다. 결론: 종양인공관절 주위 골절은 드물고 골유합도 비교적 잘 이루어지나 유합 후 합병증 최소화가 중요하다. 판형 중첩 동종골 이식술은 골유합 기간을 단축, 골질 증가, 해리위험성 감소 효과가 있으며 종양인공관절 주위 골절에 유용한 방법이다.

한국농촌보건(韓國農村保健)의 문제점(問題點)과 개선방안(改善方案) (Innovative approaches to the health problems of rural Korea)

  • 노인규
    • 농촌의학ㆍ지역보건
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    • 제1권1호
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    • pp.5-9
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    • 1976
  • The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

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