• 보건의료산업학회지
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• 제2권1호
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• pp.105-124
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• 2008

The purpose of this research is to provide the data base for the activation of Quality Improvement operation through investigating the status of Quality Improvement operation, and finding out factors influencing on the goal-orientation of QI performers in the medical centers of more than one hundred beds where are practicing Quality Improvement operation. In order to reach the purpose, document study was carried out grounded on the proceeding researches and formulated statistical data in relation with the status of Quality Improvement performers, and proof study was carried out through questionnaire survey. The subjects of the survey were the Quality Improvement performers working in seventy three medical centers in Pusan-Gyeongnam, Daegu-Gyeongbuk, and Ulsan. Among eighty three Quality Improvement performers, fifty, five were questionnaire surveyed, on the result of which Reliability Analysis, Factor Analysis, and Multiple Regression Analysis were made, using statistical program. The the results of the proof analysis on this research are as follows. First, in the factors influencing the devoting to goal pursuit of QI performers, organization-goal contribution(0.44) had significant positive effects, while organization conflict(-0.25) had significant negative effects. In other words, the higher the organization-goal contribution was, the higher the devoting to goal pursuit was, while the less the organization conflict was, the higher the devoting to goal pursuit was, which was statistically significant.(p<0.05). Second, in the aspect of goal performance types of QI performers, the process-centered type showed high level of the devoting to goal pursuit, which was statistically significant.(p<0.05). Third, in the aspect of QI performance degree, the higher the devoting to goal pursuit was, the higher the QI performance degree was, which was statistically significant.(p<0.05). In addition, the performers who perceived their workplaces organic structure showed much higher QI performance degree, which statistically significant.(p<0.05). Generalizing the results of this research, it is possible to offer a few suggestions as follows. First, as the competition among the medical centers is more severe recently owing to medical center evaluation system, medical centers are practicing various Quality Improvement operation in all of medical services such as clinical performance and management performance, to reach the purpose of both cost-cutting and medical quality improvement. Thus in order to practice Quality Improvement operation more efficiently in medical centers, it is essential to nuke use of problem-solving methods and statistical members. This as the willingness of chief executives and positive attitude and recognition of organization members. This requires the installation of divisions in charge and disposition of persons in charge, not to speak of persistent training of Quality Improvement. Second, the divisions in charge of QI carry out Quality Improvement operation at the medical center level, and take the role of generalizing and adjusting QI performances of various departments. Owing to this role, the division in charge of QI is considered indispensable organization in the QI operation of medical centers along with medical QI committee, while it contributes to the government's goal of reducing quality level gaps among medical centers. Therefore it is necessary for government and QI organizations to give institutional support and resources for the sake of QI operation of medical centers, besides to supply systematic trainning and informations to the divisions and persons in charge of QI. Third, it is certain that disposition of persons in charge should be determined in view of the scale and the scope of QI operation in medical centers.

• 식물조직배양학회지
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• 제24권1호
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• pp.1-35
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• 1997

Fertilized egg, by successive cell divisions, differentiates into different tissues and organs with various structures and functions. Different cells and tissues contain different proteins, products of selective gene expression. Not all the genes in any genomes are equally active, temporal and spatial gene expression being the general rule. Present paper attempts to review the tanscriptional mechanisms or the initiations of transcription from several angles. In some of the organisms the genes in the process of transcription or the genes in the inactive state can be seen under the light microscope. Some bands of Drosophila polytene chromosomes may exhibit a swollen or puff appearance under certain conditions. A puff, unfolded or decondensed form of chromomere, represents sets of intense transcriptional activity or RNA synthesis. The heterochromatic X chromosome whose genes remain inactive in the female mammals can be visualized as a dark staining structure called Barr body, Configuration of chromatin differs between transcribed and nontranscribed chromatin. Modification to the chromatin facilitates RNA synthesis. The movement of large polymerase molecule along the DNA would probably be facilitated if some modifications of the chromatin configuration is effected. Methylation of cytosines in CG sequences is associated with inactive genes. Methylation can play a role in determination of mammalian cells during embryogenesis. Demethylation is necessary for the gene to be expressed during development A histone modification that is also known to be correlated with transcriptional capacity of chromatin is acetylation of the lysine residues of the core histones. Chromatin containing a high level of histone acetylation is very sensitive to DNase 1. For the transcription to occur TBP must first bind to the TATA box. Another TF, TF IIB, then binds to the promoter-TBP complex, facilitating the access of RNA polymerase to the transcription initiation site. As recently as eight years ago researchers assumed that histones were irrelevant to the regulation of gene expression. Histones combine with the DNA to form nucleosome of the chromatin. Histones are vital participant in gene regulation. Histone and basal factors compete for access to TATA box. When DNA is exposed to basal factors before histones are introduced, the basal factors assemble on TATA boxes preventing the access of histones, allowing transcription to occur, for transcription to begin, activator protein at the upstream activation sequence or enhancer must interact with the tail of histone H4 at TATA box and cause the histone role particle to dissociate from the TATA box leading to partial breakup of the histone core particle and allowing the basal factors to bind to the TATA box. New concept of genomic flux in contrast to the old concept of static genome has been developed based on the powerful new molecular techniques. Genomic changes such as repetitive DNAs and transposable elements, it is assumed but not yet proved, may affect some of the developmental patterns that characterize particular cells, tissues, organs, and organisms. In the last decade or so remarkable achievement have been made in the researches of the structures and functions of TFs and the specific target sequences located in promoters or enhancers where these TFs bind. TFs have independent domains that bind DNA and that activate transcription. DNA binding domain of TFs serves to bring the protein into the right location. There are many types of DNA binding domains. Common types of motifs can be found that are responsible for binding to DNA. The motifs are usually quite short and comprise only a small part of the protein structure. Steroid receptors have domains for hormone binding, DNA binding, and activating transcription. The zinc finger motif comprises a DNA binding domain. Leucine zipper consist of a stretch of amino acids with a leucine residue in every seventh position Two proteins form a dimer because they interact by means of leucine zippers on similar α-helical domain. This positions their DNA binding basic domains for interaction with the two halves of a DNA sequence with dyad symmetry of TGACTCA, ACTGAGT.

• 대한예방한의학회지
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• 제6권1호
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• pp.51-95
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• 2002

1. As a point at issue of occidental medicine examination, followings have been indicated, 1) Occidental medical examination is performed by mainly test and instrument and therefore, role of doctors could be excluded and it could be diagnosed only for target disease and 2) in Korea, it could not be conducted in public medical system and therefore improvement effect of public health promotion could not be made due to increase of total medical expenses and infirmity of post management. These points are substantial limit of paradigm resided in occidental medicine and also problem caused by unique characteristics of medical system of Korea. In Korea, result of occidental medical examination show increased health risk from aged thirties and major diagnosed diseases are circulatory disease or chronic disease such as hepatic, hyperlipemic, hypertensional disease and diabetes, etc. Accounting that those chronic disease make a role as major public health risk, it is difficult that medical examination by only occidental medicine make effect on public health promotion. 2. Characteristics of oriental medicine examination could be summarized as diagnosis (information acquisition based on the facts) and demonstration (speculation based on acquired information) and in addition, quadruple diagnosis, as a medical examination method, include test as well as basic examination. Accounting on oriental medical examination, principally it is performed by independent herbalist and therefore, herbalist could acquire systemic result during first medical examination. Based on the theory of inner-outer examination, oriental medical examination has a principle of universe theory, systemic analysis of quadruple diagnosis, demonstration & reasoning. In addition, root of oriental medical examination could be found in pre-disease theory, a principal theory of oriental medicine. Pre-disease service could prove the advantage of oriental medicine in medical examination activities and therefore, it is needed that content of oriental medical examination should be actualized in current medical system. 3. In this study, oriental medical examination program, comprised of pulse-diagnosis, contrast muscular taking and medical consultation of herbalist is progressed communally with occidental medical examination. As pre-examination, questionary was given of general characteristics, health promoting life style, physical constitution and subjective symptom of musculoskeletal system. In addition, post-examination notification was given to subjects about health promoting control, physical constitution regimen and management of musculoskeletal system. During this study program, verification was conducted for input of acquired information and difference of each information after analysis and in addition, performed was analysis of factor influencing health promoting life style and musculoskeletal subjective symptom and evaluation of relationship of physical constitution and health promoting life study. In addition, it was verified of difference between musculoskeletal subjective symptom and result of muscle contrast picture evaluation. 4. Evaluation of oriental medical examination model is divided into 2 categories of oriental medical examination-consultation and result evaluation -post management. Oriental medical examination-consultation demands establishment of examination system, standardization of examination and establishment of examination form and in addition, it should be admitted as enlarged examination assists systemic quadruple diagnosis of herbalist not a key of oriental medical examination. In addition, information acquisition for research purpose should be performed according to the systemic research plan based on the separation of questionary for examination purpose and research purpose. For evaluation of the result, it was concluded that needed are result evaluation meets oriental medical system and post-notification system, informing health management information, based on examination result. 5. Accounting on satisfaction for oriental medical examination model, affirmative reply was much higher (66%) than negative (8.64%). Satisfaction of each area was in order of consultation of herbalist, systemic muscle contrast taking, pulse examination, post-notification and questionary fill-up and dissatisfaction was in order of post-notification, questionary fill-up, consultation of herbalist, systemic muscle contrast taking and pulse measurement. Satisfaction for collaborative examination of occidental and oriental medicine was over 60% and over 75% hope oriental examination would be included in later medical examination program. Based on this result, collaborative examination including occidental and oriental medicine could increase satisfaction of subjects for medical examination program.

• Asia pacific journal of information systems
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• 제22권2호
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• pp.21-38
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• 2012

Until recently, successful implementation of ERP systems has been a popular topic among ERP researchers, who have attempted to identify its various contributing factors. None of these efforts, however, explicitly recognize the need to identify disparities that can exist between organizational information requirements and ERP systems. Since ERP systems are in fact "packages" -that is, software programs developed by independent software vendors for sale to organizations that use them-they are designed to meet the general needs of numerous organizations, rather than the unique needs of a particular organization, as is the case with custom-developed software. By adopting standard packages, organizations can substantially reduce many of the potential implementation risks commonly associated with custom-developed software. However, it is also true that the nature of the package itself could be a risk factor as the features and functions of the ERP systems may not completely comply with a particular organization's informational requirements. In this study, based on the organizational memory mismatch perspective that was derived from organizational memory theory and cognitive dissonance theory, we define the nature of disparities, which we call "mismatches," and propose that the mismatch between organizational information requirements and ERP systems is one of the primary determinants in the successful implementation of ERP systems. Furthermore, we suggest that customization efforts as a coping strategy for mismatches can play a significant role in increasing the possibilities of success. In order to examine the contention we propose in this study, we employed a survey-based field study of ERP project team members, resulting in a total of 77 responses. The results of this study show that, as anticipated from the organizational memory mismatch perspective, the mismatch between organizational information requirements and ERP systems makes a significantly negative impact on the implementation success of ERP systems. This finding confirms our hypothesis that the more mismatch there is, the more difficult successful ERP implementation is, and thus requires more attention to be drawn to mismatch as a major failure source in ERP implementation. This study also found that as a coping strategy on mismatch, the effects of customization are significant. In other words, utilizing the appropriate customization method could lead to the implementation success of ERP systems. This is somewhat interesting because it runs counter to the argument of some literature and ERP vendors that minimized customization (or even the lack thereof) is required for successful ERP implementation. In many ERP projects, there is a tendency among ERP developers to adopt default ERP functions without any customization, adhering to the slogan of "the introduction of best practices." However, this study asserts that we cannot expect successful implementation if we don't attempt to customize ERP systems when mismatches exist. For a more detailed analysis, we identified three types of mismatches-Non-ERP, Non-Procedure, and Hybrid. Among these, only Non-ERP mismatches (a situation in which ERP systems cannot support the existing information needs that are currently fulfilled) were found to have a direct influence on the implementation of ERP systems. Neither Non-Procedure nor Hybrid mismatches were found to have significant impact in the ERP context. These findings provide meaningful insights since they could serve as the basis for discussing how the ERP implementation process should be defined and what activities should be included in the implementation process. They show that ERP developers may not want to include organizational (or business processes) changes in the implementation process, suggesting that doing so could lead to failed implementation. And in fact, this suggestion eventually turned out to be true when we found that the application of process customization led to higher possibilities of failure. From these discussions, we are convinced that Non-ERP is the only type of mismatch we need to focus on during the implementation process, implying that organizational changes must be made before, rather than during, the implementation process. Finally, this study found that among the various customization approaches, bolt-on development methods in particular seemed to have significantly positive effects. Interestingly again, this finding is not in the same line of thought as that of the vendors in the ERP industry. The vendors' recommendations are to apply as many best practices as possible, thereby resulting in the minimization of customization and utilization of bolt-on development methods. They particularly advise against changing the source code and rather recommend employing, when necessary, the method of programming additional software code using the computer language of the vendor. As previously stated, however, our study found active customization, especially bolt-on development methods, to have positive effects on ERP, and found source code changes in particular to have the most significant effects. Moreover, our study found programming additional software to be ineffective, suggesting there is much difference between ERP developers and vendors in viewpoints and strategies toward ERP customization. In summary, mismatches are inherent in the ERP implementation context and play an important role in determining its success. Considering the significance of mismatches, this study proposes a new model for successful ERP implementation, developed from the organizational memory mismatch perspective, and provides many insights by empirically confirming the model's usefulness.

• 한국발생생물학회지:발생과생식
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• 제12권1호
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• pp.19-30
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• 2008

수정란이 포배로 분화하는 것은 착상을 통하여 개체 발생이 성립되는 포유동물의 발생에 있어서 핵심적인 현상이다.. 초기 배아 발생 시기동안 배아는 생존을 위한 에너지원을 공급받아야 한다. 포유동물의 난자는 보통의 경우 난자 형성 동안 많은 양의 에니지원을 세포질에 비축하지 않기 때문에 발생 동안 수란관과 자궁으로부터 물질대사와 관련돼 여러 물질, 특히 에너지원을 획득해야 한다. 탄수화물은 착상전 배아의 주 에너지원으로 알려져 있다. 포도당, 젖산염, 피르브산염은 착상 전배아 배양액에서 없어서는 않될 성분으로, 초기 배아는 그 발생 단계에 따라 이들 물질에 대한 선호도를 각기 다르게 갖고 있다. 포도당수송체(glucose transporter)와 수소이온-단당류 동향수송체($H^+$-monocarboxylate cotransporter)는 탄수화물을 수송하는 주된 매개자로 이들의 발현 수준은 일차적으로 내인성 또는 인슐린이나 포도당과 같은 외인성 요인에 동시적으로 조절을 받는다. 비록 1960년대 이후 화학적으로 규명된 BWW와 같은 배양액을 이용하여 수정란이 성공적으로 포배로 발생되고 이식 후 정상적인 새끼가 태어났어도, 발생조절에 있어서 이들 탄수화물 물질대사 산물의 역할은 잘 알려져 있지 않다. 포도당은 밀착이 진행되는 상실배에서 물질대사 관련 효소와 수송체의 발현을 조절하고, 포배강 형성에 필요로 하는 에너지를 생산하는데 관련된 것으로 인식되고 있다. 다른 한편으로 cytokine은 배아에서 탄수화물의 대사율, 그리고 물질대사율 조절을 통하여 배아 발생을 조절할 수 있는 것으로 제안되어 왔다. 또한, 근래 들어 본인 등은 젖산염이 착상 전 배아의 발생을 조절할 수 있는 물질임을 밝히고 있다. 이러한 결과들은 탄수화물의 물질대사물이 초기 배아 시기에 에너지원으로서 뿐만이 아니라 생합성 경로 및 다른 조절경로에 참여하고 있음을 의미한다. 따라서 초기 배아 발생 동안 탄수화물 대사와 대사물질은 에너지원으로서 뿐만이 아니라 수정란이 착상할 수 있는 능력을 갖춘 포배로 발생하는 것을 조절하는 조절물질로 그 중요성이 있다.

• Journal of Microbiology and Biotechnology
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• 제25권10호
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• pp.1751-1760
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• 2015

Mucin2 (MUC2), an important regulatory factor in the immune system, plays an important role in the host defense system against bacterial translocation. Probiotics known to regulate MUC2 gene expression have been widely studied, but the interactions among probiotic, pathogens, and mucin gene are still not fully understood. The aim of this study was to investigate the role of MUC2 in blocking effects of probiotics on meningitic E. coli-induced pathogenicities. In this study, live combined probiotic tablets containing living Bifidobacterium, Lactobacillus bulgaricus, and Streptococcus thermophilus were used. MUC2 expression was knocked down in Caco-2 cells by RNA interference. 5-Aza-2'-deoxycytidine (5-Aza-CdR), which enhances mucin-promoted probiotic effects through inducing production of Sadenosyl-L-methionine (SAMe), was used to up-regulate MUC2 expression in Caco-2 cells. The adhesion to and invasion of meningitic E. coli were detected by competition assays. Our studies showed that probiotic agents could block E. coli-caused intestinal colonization, bacteremia, and meningitis in a neonatal sepsis and meningitis rat model. MUC2 gene expression in the neonatal rats given probiotic agents was obviously higher than that of the infected and uninfected control groups without probiotic treatment. The prohibitive effects of probiotic agents on MUC2-knockdown Caco-2 cells infected with E44 were significantly reduced compared with nontransfected Caco-2 cells. Moreover, the results also showed that 5-Aza-CdR, a drug enhancing the production of SAMe that is a protective agent of probiotics, was able to significantly suppress adhesion and invasion of E44 to Caco-2 cells by upregulation of MUC2 expression. Taken together, our data suggest that probiotic agents can efficiently block meningitic E. coli-induced pathogenicities in a manner dependent on MUC2.

• Tuberculosis and Respiratory Diseases
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• 제60권2호
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• pp.151-159
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• 2006

목 적 : 폐암치료에 가장 널리 사용되는 cisplatin은 DNA와 결합하여 DNA 복제를 방해한다. 이렇게 손상된 부위를 복구하는 과정에 excision repair cross complementing gene 1 (ERCC1)이 작용한다. ERCC1이 활성화 되면, 정상세포는 DNA 손상을 줄일 수 있지만 종양세포의 경우 cisplatin의 효과는 감소하게 된다. 비소세포 폐암(non-small cell lung cancer, NSCLC) 환자에서 cisplatin을 포함하는 화학치료를 할 경우 예후인자로서 객담 ERCC1 정량측정의 의의를 조사하였다. 대상 및 방법 : 2001년 4월부터 2003년 8월 사이에 NSCLC로 진단되어 cisplatin과 taxane계(33명) 혹은 cisplatin과 gemcitabine(34명) 복합 화학치료를 받은 환자를 대상으로 하였다. 기관지 내시경검사를 실시한 후에 즉각 채취한 객담을 처리하여 c-DNA를 분리한 후, 객담속의 종양특이 유전자인 melanoma antigen gene (MAGE) 발현 여부는 RT-PCR로, ERCC1의 상대적 정량적 측정은 real-time PCR로 하였다. 환자의 치료반응 및 생존기간과 MAGE 발현여부 및 ERCC1의 발현정도와의 상관관계를 조사하였다. 결 과 : 객담에서 MAGE는 40.2%, ERCC1은 74.6%에서 발현되었다. ERCC1이 중앙값 이상인 경우와 미만인 군으로 나눠서 비교한 결과 ERCC1이 증가된 군의 중앙생존기간이 84주로 미만인 군의 44주보다 길었다(P=0.017). Taxane계를 사용한 군의 중앙생존기간이 79주로 gemcitabine 사용군의 47주에 비해 길었다(P=0.03). MAGE의 발현 여부는 생존기간과 유의한 관계는 없었으나, MAGE 발현군에서 ERCC1이 유의하게 증가되어 있었다(P=0.003). MAGE가 발현되지 않고 ERCC1이 증가된 군의 중앙생존기간은 103주로 그렇지 않은 군의 43주보다 길었고(P=0.008), MAGE가 발현된 경우는 두 군 간에 차이가 없었다(각각 62주 및 44주, P=0.348). 결 론 : NSCLC 환자의 객담에서 ERCC1을 정량 측정하는 것이 화학치료를 받는 환자의 생존기간을 예측하는 한 인자로 유용할 것으로 추정된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권3호
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• pp.218-228
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• 2010

발암물질로 알려진 Hydroquinone (HQ)은 치과용 합성수지를 구성하는 중요한 성분으로서 지금까지 치과용 재료영역에서 널리 사용되고 있으며 구강 내에서 HQ의 유출이 일어나는 것으로 확인 되었다. 따라서 구강암의 기원이 되는 인체상피세포의 발암화에 HQ가 미치는 영향을 평가하였다. HQ에 의한 인체세포 독성을 평가하기위해 LDH assay를 실시하고 세포 독성이 높지 않은 용량을 실험 용량으로 설정하였다. 인체 세포의 발암화를 평가하기 위해 세포 발암화 지표로서 cell saturation density, soft-agar colony formation 및 cell aggregation의 분석을 사용한 결과 고용량인 50 ${\mu}M$을 제외한 모든 용량에서 발암화 지표의 변화를 나타내지 않아 HQ의 발암력은 매우 낮은 것으로 추정된다. 그러나 발암촉진제인 TPA와 함께 투여 시 발암력의 증가를 보여 주변 환경의 여건에 따라 발암력이 증가할 수 있음을 입증하였다. HQ를 노출 후 세포사멸화를 측정하기 위해 DNA fragmentation변화를 분석한 결과 10 ${\mu}M$부터 50 ${\mu}M$까지 노출 시간 의존형의 증가를 나타내었으며 50 ${\mu}M$과 같은 고용량 농도에서는 노출시간 의존적 세포사멸 효과를 보였다. 따라서 세포 발암화를 일으킨 용량에서 세포사멸도 함께 일어나 HQ에 의한 발암화에 세포사멸이 관여함을 보였다. HQ는 ROS를 생성하였으며 Trolox, NAC와 같은 항산화물에 의한 ROS의 차단 효과와 BSO와 같은 GSH 고갈 유발 물질에 따른 ROS의 급격한 증가는 HQ가 인체세포에서 ROS를 효율적으로 생성함을 입증하는 결과이다. 세포간의 신호전달기작 조절에 중요한 역할을 하는 효소인 protein kinase C (PKC)를 immunoblot으로 분석한 결과 PKC-${\alpha}$의 활성이 증가 된 반면 PKC-${\beta}II$의 영향은 나타나지 않았다. 따라서 특정 이성질체에 대한 특이적인 효소반응이 발암화에 관여할 것으로 추정된다. 본 연구결과 치과용 합성수지 구성성분인 HQ 유출에 따른 인체상피세포의 발암성은 매우 낮은 것으로 추정되나 발암촉진제 등과의 상호작용에 의한 발암성 증가는 HQ의 구강암 발생 평가에 고려되어야 할 사항이다. 따라서 본 연구는 구강암의 예방을 위한 과학적인 접근 방법 및 기반 자료를 제시하였고 치과용 합성수지사용의 적정성에 대한 과학적인 판단을 할 수 있는 근거를 제공 하였다. 또한 본 연구 결과는 새로운 치과용 합성수지 개발의 필요성 및 개선방향을 제시 할 수 있는 근거로 활용될 수 있을 것으로 사료된다.

• 대한간호학회지
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• 제30권1호
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• pp.122-136
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• 2000

Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands′ care for their wives through a qualitative research into husbands′ experience. Method 1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won. Method 2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied. Result: 1. Husbands′ burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband′s burden correlated with the age of the patients, numbers in the family, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and the husband′s understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands′ burden is explained in 22.5% by husband′s recognition of level of severity and husbands′ age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and husband′s understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients′ experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands′ identification of housework and husbands′ concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients′ to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands′ companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

• 농촌의학ㆍ지역보건
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• 제27권2호
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• pp.107-126
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• 2002

이 연구일개 통합보건지소 관할 지역 주민들의 통합보건지소 설치 전후의 보건지소 이용 양상 및 관련 요인, 그리고 보건지소 이용 만족도에 대한 설문조사 결과와 통합 전후 보건지소의 진료 및 보건사업 실적을 비교, 분석함으로써 통합보건지소 운영이 해당 지역 주민들의 보건지소 이용에 미친 영향을 평가하여 향후 효율적인 통합보건지소 운영을 위한 기능 강화와 역할 방향을 제시하는데 기초자료를 제공하고자 수행되었다. 연구 대상지역은 통합 후 보건지소가 폐쇄되는 지역인 경주시 감포읍과 통합보건지소가 설치되는 지역인 양북면이었으며, 통합지역에 인접한 대조지역으로 선정하였다. 연구 대상지역 주민들 중 표본 추출된 일부 주민들을 대상으로 통합 전에 1차 조사(1996년 9월)를 실시하고, 보건지소가 통합된(1997년 11월)후 2000년 2월에 2차 조사를 실시하여 연구 분석 자료를 수집하였고, 통합 전후 각 보건지소의 진료 및 보건 사업 실적 등의 기존 자료를 참고하였다. 최종 연구 분석 대상자는 감포읍, 양북면, 양남면이 각각 156명, 147명, 146명이었으며, 보건지소 이용 경험률은 감포읍 지역에서는 통합 전 26.9%에서 통합 후 21.2%로 감소하였으나, 양북면 지역은 24.5%에서 29.3%로, 양남면 지역은 23.3%에서 35.6%로 증가하였다. 평균 이용횟수는 감포읍 지역에서는 2.6회에서 1.0회로 통계적으로 유의하게 감소하였으나, 양북면 지역과 대조 지역에서는 다소 증가하였다. 통합지역과 양남면에서 보건지소 이용 경험 여부와 이용 횟수의 변화에 모두 유의하게 관련된 요인은 만성질환 유무이었고, 통합지역 내 감포읍과 양북면으로 구분한 지역 변수는 통합보건지소 이용 경험에 유의한 관련 요인이었다. 만성질환 이환자들의 치료 의료기관으로는 병 의원이 가장 많았으며, 통합 지역 중 양북면에서는 통합 후 보건지소 이용이 증가하였다. 보건지소 이용 만족도는 전체적으로 통합 후 증가하였으나, 의료서비스의 유용성 점수는 다른 만족도 항목에 비하여 점수가 낮았고, 지리적 접근성 항목의 점수는 감포읍이 통합 후 유의하게 감소하였다. 통합보건지소의 일반 진료 실적은 통합지역 내 감포읍과 양북면 보건지소의 통합 전 일반 진료 실적의 총계보다 증가하였고, 예방접종 건수, 가정방문 건수, 방사선 촬영 건수, 보건교육 인원 및 상담 건수 등도 증가하였으나, 일부 만성병 관리 및 영유아 관리 인원은 감소하였다. 보건증 발급, 자동차 운전면허 적성검사, 그리고 임상병리 검사는 통합보건지소에서 새로 추가된 의료서비스였다. 양남면 보건지소에서는 일반진료 조제 건수와 보건교육 실시 인원 및 상담 건수는 증가 하였으나, 예방접종 건수, 학교보건사업실시 인원 등은 감소하였다. 이상의 결과를 정리하면 감포읍 주민들은 통합 후 보건지소 이용에 어느 정도 장애를 받고 있고, 통합보건지소 운영 성과는 기존 보건지소의 운영 성과에 비하여 크게 개선되었다고 할 수는 없으나, 통합보건지소에 대한 전반적인 만족도는 증가하였으며 새로 추가된 의료서비스는 주민들의 의료이용에 편의성을 제공하였다고 볼 수 있다. 향후 보건지소의 농어촌지역에서의 역할과 기능을 유지하고 통합보건지소 고유의 설립 취지를 살리며, 지역주민들에게 형평성 있는 일차보건의료가 제공될 수 있도록 보다 효율적인 운영 방안의 모색이 이루어져야 할 것이다.