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A Review of Improvements for Providing Safe and Secure Environments for Medical Treatment (안전한 진료환경 구축을 위한 정책 개선과제)

  • Choe, A Reum;Kim, Sung Eun;Baek, Kyoung Hee
    • Health Policy and Management
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    • v.29 no.2
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    • pp.105-111
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    • 2019
  • On December 31, 2018, an incident occurred where a doctor was attacked and killed by a patient carrying a lethal weapon in the outpatients' clinic of the psychiatric department of a tertiary general hospital. The suspect was diagnosed with bipolar affective disorder (manic depressive disorder) and has been hospitalized and cared for in the psychiatric ward of this hospital. This incident illustrates the necessity of more active cures and therapeutic intervention for mental patients with intellectual developmental disorders who require treatment considering the fact that a radical outcome has been caused by such a patient. However, on the other hand, there is also a need for an approach and analysis from the perspective of crime prevention for all medical departments. The reason for this is that even a tertiary general hospital equipped with the largest human resources, medical devices, facilities, and so forth, is susceptible to violence. As for illegal actions perpetrated against health and medical service personnel in medical institutions, such as verbal abuse, assault, injury, etc. there have neither been understanding shown for the current extent of damage in detail, nor discussions of active institutional improvement related to the seriousness of the act. It can be said that violence in the field of medical treatment is a realm requiring serious discussion and appropriate remedial actions. This is because when such incidents take place, if a patient who is supposed to get treatment from the damaged health care provider is in an urgent situation or on the waiting list of serious cases, he or she could suffer serious damage caused by deprivation of treatment opportunity, or secondary damage might be caused to the patient and/or a guardian who can hardly have an opportunity to take action. Accordingly, in this review, we would like to help create the necessary conditions for both health and medical service personnel and patients/guardians, respectively, to provide and receive medical treatment in a more secure environment. Therefore, objective assessment of the institution and issues relating to this aforementioned incident and general cases of violence occurring in medical institutions, and by suggesting legal and institutional improvements and solutions.

Evaluation of Classification Performance of Inception V3 Algorithm for Chest X-ray Images of Patients with Cardiomegaly (심장비대증 환자의 흉부 X선 영상에 대한 Inception V3 알고리즘의 분류 성능평가)

  • Jeong, Woo-Yeon;Kim, Jung-Hun;Park, Ji-Eun;Kim, Min-Jeong;Lee, Jong-Min
    • Journal of the Korean Society of Radiology
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    • v.15 no.4
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    • pp.455-461
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    • 2021
  • Cardiomegaly is one of the most common diseases seen on chest X-rays, but if it is not detected early, it can cause serious complications. In view of this, in recent years, many researches on image analysis in which deep learning algorithms using artificial intelligence are applied to medical care have been conducted with the development of various science and technology fields. In this paper, we would like to evaluate whether the Inception V3 deep learning model is a useful model for the classification of Cardiomegaly using chest X-ray images. For the images used, a total of 1026 chest X-ray images of patients diagnosed with normal heart and those diagnosed with Cardiomegaly in Kyungpook National University Hospital were used. As a result of the experiment, the classification accuracy and loss of the Inception V3 deep learning model according to the presence or absence of Cardiomegaly were 96.0% and 0.22%, respectively. From the research results, it was found that the Inception V3 deep learning model is an excellent deep learning model for feature extraction and classification of chest image data. The Inception V3 deep learning model is considered to be a useful deep learning model for classification of chest diseases, and if such excellent research results are obtained by conducting research using a little more variety of medical image data, I think it will be great help for doctor's diagnosis in future.

Korean independence activist Hong-Kyun Shin (독립운동가 신홍균 한의사에 대하여)

  • LEE Sang-hwa
    • The Journal of Korean Medical History
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    • v.35 no.2
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    • pp.69-82
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    • 2022
  • Shin Hong-gyun was born on August 20, 1881. The second son of Shin Tae-geom (申泰儉) in Sangsang-ri, Sinbukcheong-myeon, Bukcheong-gun,Hamgyeongnam-do. His family had been practicing East Asian medicine as a family business. At that time, the families of East Asian doctors who passed the general examination of the Joseon Dynasty had been continuing the East Asian medicine business from generation to generation. Starting with exile in North Gando in 1911, he was located in Wangga-dong, 17 Doo-gu, Changbaek-hyeon. In 1915, he met General Choi Un-san in Bongo-dong, treated the soldiers suffering from cellulitis, and participated in the training process to prepare for the upcoming anti-Japanese war. However, because of a growing difference of opinion with General Choi Woon-san, Shin Hong-gyun left Bono-dong after a year and mets Sorae Kim Jung-geon and joined the founding of Wonjonggyo and Daejindan, an anti-Japanese armed group. It is said that Shin Hong-gyun established many schools in Korean villages destroyed by the Gyeongshin disaster and 14 schools were established under the names of Wonjonggyo and Daejin. After the Japanese established the puppet Manchukuo in 1931, the Manchurian Defense Forces were formed. Koreans and Chinese immigrants to Manchuria worked together to carry out a joint Korean-Chinese anti-Japanese operation towards the Japanese Empire. In 1933, 50 of the Daejindan members joined the Korean Independence Army, and among them, Shin Hong-gyun began to work as a medical doctor in earnest. During an ambush in Daejeonryeong Valley, he could not get a proper meal and, to make matters worse, got wet in the rainy season, so the situation was a challenge in various ways. At this time, Shin Hong-gyun showed his knowledge of herbal medicine, picked black wood ear mushrooms that grew wild in the mountains, washed them in rain water, and provided food to the independence fighters and relieved them of hunger. After the Battle of Daejeon-ryeong, the Japanese army's suppression of the independence forces intensified, and most of the independence fighters escaped from the Chinese army's encirclement and were scattered. Ahn Tae-jin and others led the remaining units and continued the anti-Japanese armed struggle in the forest areas of Yeongan, Aekmok, Mokneung, and Milsan.

The Effect of Hospital Service Quality on Emotional Attachment, Perceived Value, and Customer Satisfaction (병원서비스품질이 감정적 애착과 지각된 가치 및 고객만족도에 미치는 영향)

  • Sin, Kyung-sook;An, Un-seok
    • Journal of Venture Innovation
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    • v.4 no.3
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    • pp.49-67
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    • 2021
  • This study analyzed the effects of hospital service quality, emotional attachment, and perceived value on customer satisfaction. In particular, the purpose of this study was to understand the role of emotional attachment and perceived value in the relationship between hospital service quality and customer satisfaction. For this purpose, the results of structural equation model analysis with the data collected by conducting a survey on customers visiting small and medium-sized hospitals were as follows. First, hospital service quality felt by hospital customers had a significant effect on emotional attachment and customer satisfaction, but had no significant effect on perceived value. Second, the emotional attachment felt by customers who visited the hospital had a significant effect on perceived value and customer satisfaction. Third, emotional attachment felt by customers in the relationship between hospital service quality and customer satisfaction had a significant mediating effect. Through the above results, it was confirmed that the service quality felt by customers visiting the hospital leads to attachment to the doctor's competence and medical technology competency, which leads to an increase in customer satisfaction through this attachment. The implications obtained based on these results are as follows. In order for the service quality felt by the customers who visit the hospital to lead to customer satisfaction, above all, it is important to focus on the emotional attachment they can have and find a strategy to improve the service quality. In other words, it is necessary to establish excellent medical staff and medical technology so that hospital customers can have high confidence in the competence of doctors and medical technology, and establish a public relations strategy that can effectively display these competences. Through these efforts, hospital customers will feel a strong attachment to doctors and medical technology, which will increase their satisfaction with the hospital.

A Study on Oriental Medical Diagnosis of Musculoskeletal Disorders using Moire Image (Moire 영상을 이용한 근골격계 질환의 한의학적 진단에 관한 연구)

  • Lee Eun-Kyoung;Yu Seung-Hyun;Lee Su-Kyung;Kang Sung-Ho;Han Jong-Min;Chong Myong-Soo;Chun Eun-Joo;Song Yung-Sun;Lee Ki-Nam
    • Journal of Society of Preventive Korean Medicine
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    • v.4 no.2
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    • pp.72-92
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    • 2000
  • This research has conducted studies on an Oriental medicine-based method of diagnosing of occupational musculoskeletal system diseases. This researcher has searched through existing relevant medical literature. Also, this researcher has worked on a moire topography using moire topography. In this course, this researcher has reached the following conclusion in relation to the possibility of using a moire topography as a diagnosing device of musculoskeletal system diseases under Oriental medicine . 1 The Western medicine outlines its criteria of screening occupational musculoskeletal system diseases as follows A. The occupational musculoskeletal diseases must clearly include one or more of the subjective symptoms characterized by pain, hypoesthesia dysaesthesia, anaesthesia. etc . B, There should be clinically admitted objective observations and diagnosis outlining that the disease concerned shows symptoms such as tenderness, induration. and edema that can appear with occupational musculoskeletal system diseases. dyscinesia should be admitted with the disease concerned, or there should be observations and diagnosis outlining that abnormality exists in electric muscular or nervous diagnosis and examination . C. It should be admitted that prior to the occurrence of symptoms or observations and diagnosis on musculoskeletal system-related diseases, a patient has been engaged in works with conditions requiring improper work posture or work movement. That is, this is an approach whereby they see abnormality in the musculoskeletal system come from material and structural defect, and adjust and control abnormality in the musculoskeletal system and secreta . 2. The Oriental medicines sees that a patient develops the pain of occupational musculoskeletal diseases as he cannot properly activate the flow of his life force and blood thus not only causing formation of lumps in the body and blocking the flow of life force and blood in some parts of the body. Hence, The Oriental medicine focuses on resolving the cause of weakening the flow of life force and blood, instead of taking material approach of correcting structural abnormality Furthermore , Oriental medicine sees that when muscle tension builds up, this presses blood vessels and nerves passing by, triggering circulation dyscrasia and neurological reaction and thus leading to lesion. Thus, instead of taking skeletal or neurophysiological approach. it seeks to fundamentally resolve the cause of the flow of the life force and blood in muscles not being activated. As a result Oriental medicine attributes the main cause of musculoskeletal system diseases to muscle tension and its build-up that stem from an individual's long formed chronicle habit and work environment. This approach considers not only the social structure aspect including companies owners and work environment that the existing methods have looked at, but also individual workers' responsibility and their environmental factors. Hence, this is a step forward method. 3 The diagnosis of musculoskeletal diseases under Oriental medicine is characterized by the fact that an Oriental medicine doctor uses not only photos taken by himself, but also various detection devices to gather information and pass comprehensive judgment on it. Thus, it is the core of diagnosis under Oriental medicine to develop diagnosing devices matching the characteristics of information to be induced and to interpret information so induced from the views of Oriental medicine. Diagnosis using diagnosing devices values the whole state of a patient and formal abnormality alike, and the whole balance and muscular state of a patient serves as the basis of diagnosis. Hence, this method, instead of depending on the information gathered from devices under Western medicine, requires devices that provide information on the whole state of a patient in addition to the local abnormality information that X-ray. CT, etc., can offer. This method sees muscle as the central part of the abnormality in the musculoskeletal system and thus requires diagnosing devices enabling the muscular state. 4. The diagnosing device using moire topography under Oriental medicine has advantages below and can be used for diagnosing musculoskeletal system diseases with industrial workers . First, the device can Provide information on the body in an unbalanced state. and thus identify the imbalance and difference of height in the left and right stature that a patient can not notice at normal times. Second, the device shows the twisting of muscles or induration regions in a contour map. This is not possible with existing shooting machines such as X-ray, CT, etc., thus differentiating itself from existing machines. Third, this device makes it possible for Oriental medicine to take its unique approach to the abnormality in the musculoskeletal system. Oriental medicine sees the state and imbalance state in muscles as major factors in determining the lesion of musculoskeletal system, and the device makes it possible to shoot the state of muscles in detail. In this respect, the device is significant. Fourth, the device has an advantage as non-aggression diagnosing device.

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Characteristics and development plan of Home Economics teachers' culture (가정과교사 문화의 특징과 발전 방안)

  • Kim, Seung-Hee;Chae, Jung-Hyun
    • Journal of Korean Home Economics Education Association
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    • v.30 no.2
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    • pp.77-102
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    • 2018
  • The purpose of this study was to contribute to Home Economics(HE) teachers' culture by figuring out acknowledging characteristics of cultures of HE teachers and impeding factors on development of HE education. For this intensive interview were used. Intensive interviews were made with 14 HE teachers who completed coursework for master's or doctor's program of graduate school and belong to HE Teachers' Study Associations of each region or Korean Home Economics Education Association and analyzed by subject analysis method. The results of the study are as follows. First, HE teachers establish the philosophy of HE education, and practice education to provide profit to adolescents, their families, as well as society through HE class with their belief that HE is a practical and critical subject to benefit individual adolescents, families, and society. Second, HE teachers form culture to make an effort to continue to improve their expertises by attending graduate school, joining HE teachers' associations to enhance teaching methods, evaluation methods, and work ability or disclosing their own class. Third, HE teachers settle culture to conduct classes focusing on practical issues by converting the paradigm of HE education to that of practical critique. They also see that the system of three actions(technical action, communicative action, and emancipative action) should be applied in circulating ways to improve quality and value of life. Forth, for impeding factors of development of HE education, there are educational system and social recognition. However, with HE teachers' efforts, HE education settles well, as it reflects demands from students and society, finds students' talents, and actualizes its own goals. HE teachers believe that student will recognize that HE education is necessary for happiness of individuals and families. As a way to develop Home Economics teacher culture, Home Economics teachers should have the opportunity to develop more Home Economics teachers by participating in and working in research sessions in each area. It also called for a control tower to enable and lead collaborative networks between local Home Economics curriculum research committees. The Korean Home Economics Education Association should play a central role in the academic research community of each region and be able to help Home Economics teachers by moving more quickly and systematically to cope with the upcoming changes in education. Finally, participants said that in order to prepare a basic framework for the change in Home Economics education, practical critical Home Economics teacher training are needed. To this end, students can understand the essence of Home Economics education and establish their identity by taking a deeper Home Economics education curriculum philosophy for Home Economics teacher training.

THE EFFECT OF ADHD CHILD MOTHER'S DEPRESSIVE MOOD, PARENTING STRESS, AND PARENTING RELATED ATTITUDE ON PARENTING BEHAVIOR (주의력결핍과잉행동장애 아동 어머니의 우울감, 양육 스트레스 및 양육 관련 태도가 양육 행동에 미치는 영향)

  • Choi, Yoon-Young;Cho, Sun-Mi;Hong, Sung-Do;Oh, Eun-Young;Kim, Ji-Hae
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.13 no.1
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    • pp.153-162
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    • 2002
  • Summary:This study was designed to examine the effect of mother's depressive mood and parenting related attitude on parenting behavior, focusing on the cases having an ADHD child. Method:A total of 82 parents, 31 parents having children with ADHD and 51 normal, were involved in this study. The children of ADHD and normal group were 6-11 years old. ADHD group were diagnosed as attention-deficit hyperactivity disorder by psychiatric doctor and psychological evaluations using DSMIV criteria and the normal group were excluded by using Diagnostic Rating Scale-Parent, Teacher Form. The mothers of both group completed a series of questionnaire about mother's depressive mood and parenting-related attitude. To investigate the relationships between each variables, Student's t-test, correlation, stepwise regression, and hierarchical regression analysis were performed. Result:In correlation analysis, Mothers with an ADHD child were likely to report more coercive parenting behavior, more negative parenting-related attitudes, and depressive mood than normal group. In regression analysis, mother's parenting stress, dysfunctional thoughts, parenting competence, and depressive mood predicted coercive parenting behavior significantly, total explaining 50% of its variance, and especially depressive mood explained 29% of their coercive parenting behavior. These Results indicated that mother's depressive mood accounted for a substantial portion of coercive parenting behavior. Conclusion:These findings suggested that it is significantly important to reduce Mother's depressive mood through dealing with parenting sense of competence and dysfunctional thoughts, so, both parent education program and cognitive-behavioral therapeutic approach are needed to change parent's coercive parenting behavior. Finally, limitation of the present study and suggestions were discussed for further studies.

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A Study on the Current Status of the Curriculum Operation of the Basic Medical Sciences in Nursing Education (간호학교육에서 기초의.과학 교과운영에 대한 연구)

  • 최명애;신기수
    • Journal of Korean Academy of Nursing
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    • v.27 no.4
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    • pp.975-987
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    • 1997
  • The purpose of this study was to investigate the current status of curriculum operation of the basic medical sciences in nursing education at college of nursing, department of nursing and junior college of nursing, ultimately to provide the basic data to improve a curriculum of basic medical science in nursing education. 78 professors who were in charge of basic medical science at 22 colleges of nursing and department of nursing, and 20 junior colleges of nursing responded the questionnaire consisted of 22 question items about the status of objectives, lectures, laboratory practice and characteristics of professors, and mailed to the author. The findings of this study were as follows : 1. The subjects of basic medical science were identified as physiology, anatomy, biochemistry, pathology, microbiology, pharmacology in the most colleges of nursing and junior colleges of nursing. 2 colleges of nursing and department of nursing(9.1%) and 19 junior colleges of nursing(95%) did not open biochemistry, 1 college of nursing and department of nursing(5%) did not open pathology and pharmacology. 2 Junior colleges of nursing(10%) did not open pharmacology, 1 junior college of nursing(5%) did not open pathology, the other 1 junior college of nursing did not open microbiology. 2. Credits of the subjects were ranged from 1 to 4. Lecture hours of one semester of physiology at school of nursing and junior college of nursing was average 103.6 and average 102.67, that of anatomy was average 127.1 and average 98, that of microbiology was average 109.7 and average 86.33, that of biochemistry was average 105, that of pathology was average 91 and average 94, that of pharmacology was average 86 and average 85.75. 3. Most of schools used 1 textbook for lectures, 3 school of nursing and department of nursing recommended references without using textbook, while all 36 junior colleges of nursing used textbooks. 4. 5 among 10 schools of nursing and department of nursing had a laboratory practice in physiology, 4 among 7 schools in anatomy, 4 among 6 schools in biochemistry, 2 among 6 schools in pathology 5 among 6 schools in microbiology. Not all the schools had a laboratory practice in pharmacology. 4 among 9 junior colleges of nursing had a laboratory practice in physiology. 1 among 4 schools in anatomy, 2 among 7 schools in microbiology. Not all the junior colleges of nursing had a laboratory practice in pathology and pharmacology. 11 among 20 colleges of nursing and department of nursing, 4 among 7 junior schools of nursing used a textbook of laboratory practice. 5. All the subjects at school of nursing and department of nursing responded that content of lectures and laboratory practices of basic medical science should be different from that of medical education, 34 junior schools of nursing responded that content of lecture of basic medical science in nursing education should be different from that of medical education. 33 junior schools of nursing responded that content of practice of basic medical science in nursing education should be different from that of medical education. 6. The final degree of 25 professors who were in charge of basic medical science were doctors of. medicine, that of 5 professors were masters of medicine, that of 5 were doctor of pharmacology, that of 2 were a master of pharmacology, that of 1 was physical science. The final degree of 8 professors who were in charge of basic medical science were masters of medicine, 7 doctors of medicine, 4 masters of nursing science, 4 masters of pharmacology, 2 doctors of nursing, 2 doctors of physical science, 2 doctors of pharmacology and 1 master of public health. 9 full professors, 13 associate professors, 11 assist ant professors, 3 full time instructors, and 6 part time instructors were in charge of basic medical science at college of nursing and department of nursing, 20 part time instructors, 8 associate professors, 6 assistant professors, and 2 full professors were in charge of has basic medical science at junior college of nursing. Based on these results, curriculum of basic medical science in nursing education should be reviewed deeply based on nursing model.

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

  • Park Yong-Sin;Cho Byung-Hee;Kim Ho;Lee Si-Baek
    • Journal of Society of Preventive Korean Medicine
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    • v.7 no.1
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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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Maternal and Child Factors Associated with Early Detection of Cerebral Palsy (뇌성마비아 조기발견과 관련된 모자인자)

  • Bae, Sung-Soo;Park, Jung-Han
    • Journal of Preventive Medicine and Public Health
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    • v.20 no.2 s.22
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    • pp.312-321
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    • 1987
  • To investigate the maternal and child factors associated with early detection of cerebral palsy, 74 mothers of cerebral palsy children who were born since January 1, 1980 and being treated at Taegu Rehabilitation Center for the Handicapped, Rehabilitiation Center of Taegu University, St. Paul Children's House and Pusan Welfare Association of Cerebral Palsy Children were interviewed from February to April 1987. There is no association between age of child when parents noticed the child's abnormality and educational level of father but it tend to be detected earlier when education level of mother is college or above compared with high school or under. There is a trend of earlier detection of child's abnormality although statistically not significant in case father is professional or managerial worker, monthly income of father is over \610,000, child is first-born, age of the parents is 34 years or under, child is a boy, and child has periodic well-baby check-up. The child's abnormality is detected earlier when mothers had 7 prenatal visits or more compared with those who had 6 visits or less (p<0.05). Parents noticed the child's abnormality first in 85.1% of the cases whereas doctors detected it first in 2.7% and this percentage was not different whether the child had periodic well-baby check-up or not. The first physician's diagnosis of the children was cerebral palsy in 36.5% and the rest was normal, need for observation, uncertain, etc. Parents took the child to doctor for diagnosis 2-3 months after they noticed the child's abnormality and after the child was diagnosed as cerebral palsy parents either took no therapeutic measure or brought the child to physiotherapy or acupuncture or gave herb medicine before they started specific rehabilitative therapy. For early detection of the cerebral palsy children, teaching of evaluation method for child development should be reinforced both in medical school and clinical training course and should train the specialist for diagnosis and treatment of crippling conditions. Also, public education is needed for the importance of early detection of crippling conditions and currently available methods for diagnosis and treatment.

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