• 제목/요약/키워드: US health system

검색결과 243건 처리시간 0.026초

미국의 CHES 프로그램: 현대 보건교육사의 역할과 제도의 발전 (The United States CHES Program: The Role and Development of the Modern Health Educator)

  • Sohn, Ae-Ree;Burzo, Jamie
    • 보건교육건강증진학회지
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    • 제27권5호
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    • pp.63-71
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    • 2010
  • 목적: 보건교육 분야는 상대적으로 새로운 영역이나 전 세계적으로 건강증진의 중요성에 대한 요구가 강조되면서 빠르게 발전되고 있다. 많은 나라에서 보건교육사 프로그램을 제도화하는 노력을 하고 있다. 본 연구는 미국의 보건교육사 제도를 고찰함으로써 국제적 보건교육사 제도의 개발 및 발전에 기여하는 데 있다. 방법: 본 연구는 문헌고찰을 통하여 미국의 자격증 제도, 보건교육사의 역사 및 다양한 현장에서 보건교육사의 역할과 특성을 파악하였다. 결과: 보건교육사의 역할과 기술은 현장에 따라 다르게 요구되나 크게 일곱 가지의 대영역으로 분류되며, 35개의 기술 분야에서 163개의 하위기술이 필요한 것으로 나타났다. 미국은 의료비의 증가로 인하여 만성질환의 조기발견과 예방사업을 위하여 미국의 보건교육사는 2006년에 2006명에서 2016년에는 78,000명으로 증가될 것으로 전망된다. 보건교육사는 다양한 분야에서 고용되고 있으며, 주로 지역사회 건강단체, 연구소, 보건센터(병원, 의원, 보건소), 학교, 정부공무원 및 사업체 등에서 활동하고 있다. 결론: 미국의 보건교육사 제도의 발전은 보건교육사 프로그램을 개발하고 발전시키고자 하는 여러 나라에 좋은 모델이 될 수 있다. 또한 미국 보건교육사의 다양성과 전문성은 한국의 보건교육사 제도의 발전에 도움이 될 것으로 여겨진다.

Gateway RFP-Fusion Vectors for High Throughput Functional Analysis of Genes

  • Park, Jae-Yong;Hwang, Eun Mi;Park, Nammi;Kim, Eunju;Kim, Dong-Gyu;Kang, Dawon;Han, Jaehee;Choi, Wan Sung;Ryu, Pan-Dong;Hong, Seong-Geun
    • Molecules and Cells
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    • 제23권3호
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    • pp.357-362
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    • 2007
  • There is an increasing demand for high throughput (HTP) methods for gene analysis on a genome-wide scale. However, the current repertoire of HTP detection methodologies allows only a limited range of cellular phenotypes to be studied. We have constructed two HTP-optimized expression vectors generated from the red fluorescent reporter protein (RFP) gene. These vectors produce RFP-tagged target proteins in a multiple expression system using gateway cloning technology (GCT). The RFP tag was fused with the cloned genes, thereby allowing us localize the expressed proteins in mammalian cells. The effectiveness of the vectors was evaluated using an HTP-screening system. Sixty representative human C2 domains were tagged with RFP and overexpressed in HiB5 neuronal progenitor cells, and we studied in detail two C2 domains that promoted the neuronal differentiation of HiB5 cells. Our results show that the two vectors developed in this study are useful for functional gene analysis using an HTP-screening system on a genome-wide scale.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

  • Mahumud, Rashidul Alam;Sarker, Abdur Razzaque;Sultana, Marufa;Islam, Ziaul;Khan, Jahangir;Morton, Alec
    • Journal of Preventive Medicine and Public Health
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    • 제50권2호
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    • pp.91-99
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    • 2017
  • Objectives: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

해군 안전관리체계 운영에 대한 검토 및 발전 방향 고찰 (Reviewing the Operation of the Navy Safety Management System and Its Direction)

  • 한정우;김기재;이원영;박교식
    • 한국재난정보학회 논문집
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    • 제19권4호
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    • pp.859-868
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    • 2023
  • 연구목적: 해군에서 안전을 강화하기 위해 안전보건경영시스템 도입, 위험성 평가체계 개발 등의 노력을 기울이고 있으나 안전사고가 지속 발생하고 있어 안전관리체계에 대한 점검을 통해 발전방안을 제시하였다. 연구방법:해군 안전관리체계 진단을 위해 안전 환경의 변화, 문서체계, 안전보건경영시스템 운영 등을 검토하고 보완점을 찾아 개선방향을 도출하였다. 연구결과:해군의 안전 정책과 안전관리 방향을 제시할 수 있는 SMS 기준서와 이를 표준화된 방법으로 시행할 수 있는 지침을 제공하는 안전프로그램이 필요한 것을 확인하였다. 이 SMS에는 미 해군의 SMS, 국제표준 ISO 45001 규격과 우리 해군의 기존 안전관리체계를 포함한다. 결론: 해군의 안전관리체계는 안전정책과 기준을 명확하게 제시하고, 이를 시행할 수 있는 표준프로그램을 통해 안전업무의 공신력과 효용성을 갖추는 것이 필요한데 이를 위한 해군 SMS 개발이 필요하다.

Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005

  • Kim, Jae-Young;Jang, Soong-Nang
    • Journal of Preventive Medicine and Public Health
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    • 제41권3호
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    • pp.186-194
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    • 2008
  • Objectives : This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. Methods : Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. Results : Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. Conclusions : These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. Continued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

두경부 혈관종 진단시 $^{99m}Tc$-RBC Scan and SPECT 검사의 유용성 (Usefulness of $^{99m}Tc$-labeled RBC Scan and SPECT in the Diagnosis of Head and Neck Hemangiomas)

  • 오신현;노동욱;안샤론;박훈희;이승재;강천구;김재삼;이창호
    • 핵의학기술
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    • 제12권1호
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    • pp.39-43
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    • 2008
  • 혈관종의 진단에 초음파(US), 전산화단층촬영영상(CT), 자기공명영상(MRI), 핵의학 검사 등 다양한 검사방법이 사용 될 수 있지만 $^{99m}Tc$ 표지 적혈구를 이용한 혈액풀 영상검사는 단일광자단층촬영(SPECT)의 발달로 혈관종을 확진하고 배제할 수 있는 가장 경제적일 뿐 아니라 비침습적이고 시행 하기도 쉬운 확실한 방법으로 사용되고 있다. 본 연구에서는 간 혈관종 외 두경부 (head and neck) 혈관종 진단시 $^{99m}Tc$-RBC scan and SPECT 검사의 유용성에 대하여 알아보고자 한다. 혈관종의 진단을 위해 본원 핵의학과에 내원한 6명의 환자를 대상으로 하였다. 6명의 환자 중 두부 부위 4명, 경부 부위 1명은 혈관종이라 추정하였고, 1명은 혈관종으로 의심되었다. 변형 체내 표지법(modified in vivo method)을 사용하여 표지하고 원심침전시켜 혈장을 제거한 다음 $^{99m}Tc$-RBC를 순 간주사하였다. 혈류기 영상을 얻은 후 즉시 전면상, 후면상, 양측면상의 혈액풀 영상을 얻었고 4시간 후 동일한 지연 영상을 얻었다. SPECT 영상은 이중 검출기(dual head detector)를 이용하여 64 projections ($180^{\circ}$)을 시행하였고 각 projection당 30초간 집적하였다. 모든 영상을 재구성한 후에 3명의 핵의학과 전문의, 핵의학과 전공의 및 핵의학과 방사선사가 특별한 정보없이 영상을 검토하였다. 혈관종으로 추정된 5명의 환자는 혈류기 영상에서 방사능은 증가하지 않았고 혈액풀 영상에서 증가하였으며 지연 영상과 SPECT 영상에서 증가된 소견을 보여 전형적인 혈관종 소견을 보였다. 혈관종이 아닌 1명의 환자는 혈류기 영상과 혈액풀 영상에서 방사능 증가를 보였고, 지연 영상과 SPECT 영상에서 감소된 소견을 보여 혈관종이 아닌 것으로 판정되었다. 5명의 혈관종 환자의 병소 크기는 모두 2 cm 이상이었고 SPECT 영상이 지연영상과 비교하여 뚜렷하게 병소 감별을 할 수 있었다. 간혈관종뿐만 아니라 두경부 혈관종이 의심되는 경우에는 비교적 경제적이고 비침습적이며 쉽게 시행할 수 있는 $^{99m}Tc$-RBC scan and SPECT 검사를 시행함으로써 초음파, 전산화 단층촬영영상, 자기공명영상 검사와 같은 다른 영상진단법과 함께 혈관종을 확진하고 배제하는데 의미있는 영상의학적 정보를 제공할 수 있다고 사료된다.

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산업안전보건분야에서 표준직업분류(Standard Occupational Classification, SOC) 활용 사례 고찰 및 향후 국내 도입 방안 제언 (Comprehensive Review of Standard Occupational Classification (SOC) as used in the Occupational Safety and Health Field)

  • 박동욱;최상준;변혜정;김양호;김수근;하권철;강태선
    • 한국산업보건학회지
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    • 제23권1호
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    • pp.11-19
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    • 2013
  • Backgrounds: Occupations are grouped on the basis of similarity in tasks and duties performed. Standard occupational classification (SOC) is a tool for organizing all professions into a clearly defined set of groups according to the tasks and duties undertaken in the respective jobs. Objectives: The major objective of this study is to comprehensively review how a SOC system is used in occupational and safety fields such as surveillance, exposure monitoring, occupational epidemiological study, management of carcinogens and analysis of occupational accidents. Methods: We summarized the cases, policies and regulations used in SOC systems in advanced countries and as they appear in articles Results: We found that SOC systems have been widely used in various areas of occupational safety and health in the US, the UK, Finland, and the EU. In general, it is highly common to use SOC in the analysis of occupational accidents and diseases and to identify factors causing those accidents. The SOC system is also used not only for surveillance of exposure to hazardous agents and occupational health, but to manage carcinogens. In order to adjust the effects of a particular job, SOC is used in the general population health area. The Ministry of Employment and Labor (MOEL) has never used or introduced an SOC system. There have been no cases of the application of a SOC system to either the occupational safety and health field or to health surveillance for the general population in Korea. Conclusions: We suggested a need to introduce an SOC system in several occupational safety and health activities, such as work environment measurement, analysis of occupational accidents, specific physical examination and surveillance systems, etc.

의료분쟁에 관한 보건정책학적 고찰 -응급의료종사자를 중심으로- (The Legal Consideration in Emergency Medical Service System)

  • 강병우
    • 한국응급구조학회지
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    • 제3권1호
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    • pp.91-101
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    • 1999
  • The medicolegal problem can be occurred in all medical field. Especially pre-hospital stage can be more exposed to the legal claims due to the very nature of EMT business and characteristics of ER patient or their family member. All Emergency Medical Technician should be concerned about the law associated with emergency care for handling the medicolegal problem, so the legally risky situations that may be occurred in pre-hospital stage and ER practice. This study reviewed malpractice claim of emergency patients filed in at Association of malpractice patients' family and two tertiary level hospitals. Problems related to treatment and misdiagnosis. Especially issues concerning emergency medical service system including of inadequate transport, delay in triage and transport accounted for many cases of all claims. This alerts us to the seriousness of medical accidents of emergency patient. This paper suggests several items that all E.M.T and every member of ED health care team always have to remember the medicolegally risk situations, must be trained in understanding the patients' wants and desires and should have the knowledge of the law associated with emergency health care. Develop the system that can share the informations about the medicolegal events which were experienced by each ED health care institutes.

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Sensor enriched infrastructure system

  • Wang, Ming L.;Yim, Jinsuk
    • Smart Structures and Systems
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    • 제6권3호
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    • pp.309-333
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    • 2010
  • Civil infrastructure, in both its construction and maintenance, represents the largest societal investment in this country, outside of the health care industry. Despite being the lifeline of US commerce, civil infrastructure has scarcely benefited from the latest sensor technological advances. Our future should focus on harnessing these technologies to enhance the robustness, longevity and economic viability of this vast, societal investment, in light of inherent uncertainties and their exposure to service and even extreme loadings. One of the principal means of insuring the robustness and longevity of infrastructure is to strategically deploy smart sensors in them. Therefore, the objective is to develop novel, durable, smart sensors that are especially applicable to major infrastructure and the facilities to validate their reliability and long-term functionality. In some cases, this implies the development of new sensing elements themselves, while in other cases involves innovative packaging and use of existing sensor technologies. In either case, a parallel focus will be the integration and networking of these smart sensing elements for reliable data acquisition, transmission, and fusion, within a decision-making framework targeting efficient management and maintenance of infrastructure systems. In this paper, prudent and viable sensor and health monitoring technologies have been developed and used in several large structural systems. Discussion will also include several practical bridge health monitoring applications including their design, construction, and operation of the systems.

Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

  • Sangmala, Pannapa;Chaikledkaew, Usa;Tanwandee, Tawesak;Pongchareonsuk, Petcharat
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권20호
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    • pp.8993-9004
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    • 2014
  • Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.